Defining a postoperative mean arterial pressure threshold in association with acute kidney injury after cardiac surgery: a prospective observational study

He, Linling1,2,3; Liang, Silin4; Liang, Yu5; Fang, Miaoxian1; Li, Jiaxin1; Deng, Jia3,6,7; Fang, Heng3; Li, Ying1; Jiang, Xinyi8; Chen, Chunbo1,3,6,9

2022-12-01

10.1007/s11739-022-03187-3

Internal and Emergency Medicine   影响因子和分区

1828-0447

1970-9366

Acute kidney injury (AKI) is a common but fatal complication after cardiac surgery. In the absence of effective treatments, the identification and modification of risk factors has been a major component of disease management. However, the optimal blood pressure target for preventing cardiac surgery-associated acute kidney injury (CSA-AKI) remains unclear. We sought to determine the effect of postoperative mean arterial pressure (MAP) in CSA-AKI. It is hypothesized that longer periods of hypotension after cardiac surgery are associated with an increased risk of AKI. This prospective cohort study was conducted on adult patients who underwent cardiac surgery requiring cardiopulmonary bypass at a tertiary center between October 2018 and May 2020. The primary outcome is the occurrence of CSA-AKI. MAP and its duration in the ranges of less than 65, 65 to 74, and 75 to 84 mmHg within 24 h after surgery were recorded. The association between postoperative MAP and CSA-AKI was examined by using logistic regression. Among the 353 patients enrolled, 217 (61.5%) had a confirmed diagnosis of CSA-AKI. Each 1 h epoch of postoperative MAP less than 65 mmHg was associated with an adjusted odds ratio of 1.208 (95% CI, 1.007 to 1.449; P = 0.042), and each 1 h epoch of postoperative MAP between 65 and 74 mmHg was associated with an adjusted odds ratio of 1.144 (95% CI, 1.026 to 1.275; P = 0.016) for CSA-AKI. A potentially modifiable risk factor, postoperative MAP less than 75 mmHg for 1 h or more is associated with an increased risk of CSA-AKI.

Mean arterial pressure Acute kidney injury Hypotension Cardiac surgery Intensive care unit Hemodynamics

SCI

英语

非南科大

General & Internal Medicine

Medicine, General & Internal

WOS:000905440000001

SPRINGER-VERLAG ITALIA SRL

Web of Science

1.Guangdong Prov Peoples Hosp, Guangdong Acad Med Sci, Guangdong Cardiovasc Inst, Dept Intens Care Unit Cardiovasc Surg, 96 Dongchuan Rd, Guangzhou 510080, Peoples R China
2.Shantou Univ, Med Coll, Shantou 515000, Peoples R China
3.Guangdong Prov Peoples Hosp, Guangdong Acad Med Sci, Dept Crit Care Med, 106 Zhongshan Er Rd, Guangzhou 510080, Peoples R China
4.South Univ Sci & Technol, Jinan Univ, Shenzhen Peoples Hosp, Affiliated Hosp 1,Clin Med Coll 2,Dept Crit Care M, Shenzhen 518020, Peoples R China
5.Guangdong Prov Peoples Hosp, Guangdong Acad Med Sci, Guangdong Cardiovasc Inst, Dept Cardiol,Guangdong Prov Key Lab Coronary Heart, Guangzhou 510080, Peoples R China
6.Southern Med Univ, Sch Clin Med 2, Guangzhou 510515, Peoples R China
7.Dalian Med Univ, Hosp 2, Dept Crit Care Med, Dalian 116023, Peoples R China
8.South China Univ Technol, Sch Med, Guangzhou 510006, Peoples R China
9.Maoming Peoples Hosp, Dept Emergency Med, 101 Weimin Rd, Maoming 525000, Peoples R China

He, Linling,Liang, Silin,Liang, Yu,et al. Defining a postoperative mean arterial pressure threshold in association with acute kidney injury after cardiac surgery: a prospective observational study[J]. Internal and Emergency Medicine,2022.

He, Linling.,Liang, Silin.,Liang, Yu.,Fang, Miaoxian.,Li, Jiaxin.,...&Chen, Chunbo.(2022).Defining a postoperative mean arterial pressure threshold in association with acute kidney injury after cardiac surgery: a prospective observational study.Internal and Emergency Medicine.

He, Linling,et al."Defining a postoperative mean arterial pressure threshold in association with acute kidney injury after cardiac surgery: a prospective observational study".Internal and Emergency Medicine (2022).