根据最新定义重新探讨中心静脉压与脓毒症相关性急性肾损伤风险之间的关联：MIMIC-IV数据库分析
Re-exploring the association between the central venous pressure and the risk of sepsis-associated acute kidney injury according to the latest definition: Analysis of the MIMIC-IV database.
作者信息
Liu Yingxiu, Ren Baiqing, Cheng Muqiao, Du Junming, Ren Rongrong
机构信息
Yingxiu Liu, M.D Department of Anesthesiology and Surgical Intensive Care Unit, XinHua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
Baiqing Ren, M.D Department of Anesthesiology and Surgical Intensive Care Unit, XinHua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China.
出版信息
Pak J Med Sci. 2025 May;41(5):1393-1401. doi: 10.12669/pjms.41.5.12047.
OBJECTIVE
The lack of a standard definition for sepsis-associated acute kidney injury (SA-AKI) makes the association between central venous pressure (CVP) and SA-AKI risk unclear. This study analyzed the relationship between CVP levels and the incidence and mortality of SA-AKI based on the most recent definition of the disease.
METHODS
This retrospective observational study utilized clinical records of sepsis patients from 2008 to 2019 admitted to the critical care unit (ICU) and in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included. Based on the Acute Disease Quality Initiative (ADQI) definition of SA-AKI, patients were stratified into SA-AKI and non-SA-AKI groups. Patients were further categorized into four groups based on the CVP levels by the optimal prediction of SA-AKI incidence retrospectively. Cox proportional hazards models and a restricted cubic splines (RCS) model were employed to evaluate the relationship between CVP levels and SA-AKI risk. Additionally, Kaplan-Meier survival analysis was conducted to compare disparities in primary and secondary endpoints across groups stratified by CVP levels.
RESULTS
A total of 6129 patients were included. An independent relationship was observed between CVP levels and the risk of SA-AKI (p <0.001). Cox proportional hazards analysis demonstrated that SA-AKI incidence increased by 33% in patients with CVP≥10.19mmHg and 48% in patients with CVP≥13.67mmHg compared to patients with CVP<6.87mmHg. RCS analysis demonstrated a U-shaped association between CVP levels and mortality. In addition, the 90-day mortality risk decreased when CVP was between 4.89 and 13.12 mmHg (p< 0.001).
CONCLUSION
Elevated CVP levels are associated with the occurrence of SA-AKI in sepsis patients. Maintaining CVP levels between 4.89mmHg and 10.19mmHg may help reduce the incidence and mortality of SA-AKI.
目的
脓毒症相关急性肾损伤（SA-AKI）缺乏标准定义，使得中心静脉压（CVP）与SA-AKI风险之间的关联尚不清楚。本研究基于该疾病的最新定义，分析了CVP水平与SA-AKI的发病率和死亡率之间的关系。
方法
这项回顾性观察性研究利用了2008年至2019年入住重症监护病房（ICU）的脓毒症患者的临床记录，并纳入了重症监护医学信息数据库IV（MIMIC-IV）。根据SA-AKI的急性疾病质量倡议（ADQI）定义，将患者分为SA-AKI组和非SA-AKI组。通过回顾性地对SA-AKI发病率进行最佳预测，根据CVP水平将患者进一步分为四组。采用Cox比例风险模型和受限立方样条（RCS）模型来评估CVP水平与SA-AKI风险之间的关系。此外，进行Kaplan-Meier生存分析以比较按CVP水平分层的各组在主要和次要终点方面的差异。
结果
共纳入6129例患者。观察到CVP水平与SA-AKI风险之间存在独立关联（p<0.001）。Cox比例风险分析表明，与CVP<6.87mmHg的患者相比，CVP≥10.19mmHg的患者SA-AKI发病率增加33%，CVP≥13.67mmHg的患者增加48%。RCS分析表明CVP水平与死亡率之间呈U形关联。此外，当CVP在4.89至13.12 mmHg之间时，90天死亡风险降低（p<0.001）。
结论
CVP水平升高与脓毒症患者发生SA-AKI相关。将CVP水平维持在4.89mmHg至10.19mmHg之间可能有助于降低SA-AKI的发病率和死亡率。
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