UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients - A retrospective analysis

Ostermann, M; Hall, A; Crichton, S; (2017) Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients - A retrospective analysis. BMC Nephrology , 18 (1) , Article 151. 10.1186/s12882-017-0568-8. Green open access

[thumbnail of s12882-017-0568-8.pdf]
Preview
Text
s12882-017-0568-8.pdf - Published Version

Download (704kB) | Preview

Abstract

BACKGROUND: The aim was to investigate whether mean perfusion pressure (MPP) calculated as the difference between mean arterial pressure (MAP) and central venous pressure (CVP) was associated with risk of progression from AKI I to AKI III in critically ill patients. METHODS: Retrospective analysis of adult patients admitted to a multi-disciplinary adult intensive care unit (ICU) between July 2007 and June 2009 who developed AKI I and in whom advanced haemodynamic monitoring was initiated within 12 h of diagnosis of AKI I. We compared patients with a MPP above and below the median value in the first 12 h of diagnosis of AKI. Multivariable logistic regression analyses were performed to identify independent risk factors for progression to AKI III, to explore the impact of MAP and CVP separately, and to investigate the impact of MPP in pre-defined sub-groups. RESULTS: Among 2118 ICU patients, 790 patients (37%) developed AKI I of whom 205 underwent advanced haemodynamic monitoring within 12 h of AKI stage I. Their median MPP was 59 mmHg. AKI I patients with a MPP ≤59 mmHg had a significantly higher risk of progressing to AKI stage III (48.6% versus 34%, respectively; p = 0.0034). This association was stronger in patients with ischemic heart disease, congestive cardiac failure or without pre-existing hypertension and in patients with a MAP <65 mmHg for >1 h. As individual components, a raised CVP was independently associated with progression to AKI stage III but MAP alone was not an independent risk factor for AKI progression. CONCLUSION: MPP <60 mmHg was independently associated with AKI progression. CVP was the key component of MPP.

Type: Article
Title: Low mean perfusion pressure is a risk factor for progression of acute kidney injury in critically ill patients - A retrospective analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1186/s12882-017-0568-8
Publisher version: https://doi.org/10.1186/s12882-017-0568-8
Language: English
Additional information: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Keywords: Acute kidney injury, Central venous pressure, Mean perfusion pressure, Haemodynamics, Risk of progression
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/10038953
Downloads since deposit
67Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item