TY - JOUR
T1 - Relative Hypotension and Adverse Kidney-related Outcomes among Critically III Patients with Shock A Multicenter, Prospective Cohort Study
AU - Panwar, Rakshit
AU - Tarvade, Sanjay
AU - Lanyon, Nicholas
AU - Saxena, Manoj
AU - Bush, Dustin
AU - Hardie, Miranda
AU - Attia, John
AU - Bellomo, Rinaldo
AU - Van Haren, Frank
N1 - Funding Information:
A complete list of REACT Shock Study Investigators and the ANZICS Clinical Trials Group may be found before the beginning of the REFERENCES. Supported by the New South Wales Health Ph.D. scholarship (R.P., chief investigator) and partly funded by the John Hunter Hospital Charitable Trust and Royal Brisbane and Women’s Health Foundation. Author Contributions: R.P.: study concept. R.P., S.T., N.L., D.B., and M.H.: data acquisition. R.P. and D.B.: full access to study data and responsibility for the integrity of the data. R.P., N.L., M.S., M.H., J.A., R.B., and F.V.H.: study design. All authors: obtainment of funding and contribution to analysis and interpretation of data. R.P.: drafting of the manuscript. R.P., N.L., J.A., R.B., and F.V.H.: critical revision of the manuscript for important intellectual content. R.P. and J.A.: statistical analysis. All authors: administrative, technical, or material support.
Publisher Copyright:
Copyright 2020 by the American Thoracic Society.
PY - 2020/11/15
Y1 - 2020/11/15
N2 - Rationale: There are no prospective observational studies exploring the relationship between relative hypotension and adverse kidney-related outcomes among critically ill patients with shock. Objectives: To investigate the magnitude of relative hypotension during vasopressor support among critically ill patients with shock and to determine whether such relative hypotension is associated with new significant acute kidney injury (AKI) or major adverse kidney events (MAKE) within 14 days of vasopressor initiation. Methods: At seven multidisciplinary ICUs, 302 patients, aged >= 40 years and requiring >= 4 hours of vasopressor support for nonhemorrhagic shock, were prospectively enrolled. We assessed the time-weighted average of the mean perfusion pressure (MPP) deficit (i.e., the percentage difference between patients' preillness basal MPP and achieved MPP) during vasopressor support and the percentage of time points with an MPP deficit > 20% as key exposure variables. New significant AKI was defined as an AKI-stage increase of two or more (Kidney Disease: Improving Global Outcome creatinine-based criteria). Measurements and Main Results: The median MPP deficit was 19% (interquartile range, 13-25), and 54% (interquartile range, 19-82) of time points were spent with an MPP deficit > 20%. Seventy-three (24%) patients developed new significant AKI; 86 (29%) patients developed MAKE. For every percentage increase in the time-weighted average MPP deficit, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 5.6% (95% confidence interval, 2.2-9.1; P = 0.001) and 5.9% (95% confidence interval, 2.2-9.8; P = 0.002), respectively. Likewise, for every one-unit increase in the percentage of time points with an MPP deficit > 20%, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 1.2% (0.3-2.2; P = 0.008) and 1.4% (0.4-2.4; P = 0.004), respectively. Conclusions: Vasopressor-treated patients with shock are often exposed to a significant degree and duration of relative hypotension, which is associated with new-onset, adverse kidney-related outcomes.
AB - Rationale: There are no prospective observational studies exploring the relationship between relative hypotension and adverse kidney-related outcomes among critically ill patients with shock. Objectives: To investigate the magnitude of relative hypotension during vasopressor support among critically ill patients with shock and to determine whether such relative hypotension is associated with new significant acute kidney injury (AKI) or major adverse kidney events (MAKE) within 14 days of vasopressor initiation. Methods: At seven multidisciplinary ICUs, 302 patients, aged >= 40 years and requiring >= 4 hours of vasopressor support for nonhemorrhagic shock, were prospectively enrolled. We assessed the time-weighted average of the mean perfusion pressure (MPP) deficit (i.e., the percentage difference between patients' preillness basal MPP and achieved MPP) during vasopressor support and the percentage of time points with an MPP deficit > 20% as key exposure variables. New significant AKI was defined as an AKI-stage increase of two or more (Kidney Disease: Improving Global Outcome creatinine-based criteria). Measurements and Main Results: The median MPP deficit was 19% (interquartile range, 13-25), and 54% (interquartile range, 19-82) of time points were spent with an MPP deficit > 20%. Seventy-three (24%) patients developed new significant AKI; 86 (29%) patients developed MAKE. For every percentage increase in the time-weighted average MPP deficit, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 5.6% (95% confidence interval, 2.2-9.1; P = 0.001) and 5.9% (95% confidence interval, 2.2-9.8; P = 0.002), respectively. Likewise, for every one-unit increase in the percentage of time points with an MPP deficit > 20%, multivariable-adjusted odds of developing new significant AKI and MAKE increased by 1.2% (0.3-2.2; P = 0.008) and 1.4% (0.4-2.4; P = 0.004), respectively. Conclusions: Vasopressor-treated patients with shock are often exposed to a significant degree and duration of relative hypotension, which is associated with new-onset, adverse kidney-related outcomes.
KW - blood pressure deficit
KW - relative hypotension
KW - acute kidney injury
KW - intensive care
KW - shock
KW - Shock
KW - Intensive care
KW - Acute kidney injury
KW - Blood pressure deficit
KW - Relative hypotension
UR - http://www.scopus.com/inward/record.url?scp=85096202571&partnerID=8YFLogxK
U2 - 10.1164/rccm.201912-2316OC
DO - 10.1164/rccm.201912-2316OC
M3 - Article
SN - 1073-449X
VL - 202
SP - 1407
EP - 1418
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 10
ER -