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Critical Care
Published in: Critical Care 6/2013

Open Access 01-12-2013 | Research

Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study

Authors: Meri Poukkanen, Erika Wilkman, Suvi T Vaara, Ville Pettilä, Kirsi-Maija Kaukonen, Anna-Maija Korhonen, Ari Uusaro, Seppo Hovilehto, Outi Inkinen, Raili Laru-Sompa, Raku Hautamäki, Anne Kuitunen, Sari Karlsson, the FINNAKI Study Group

Published in: Critical Care | Issue 6/2013

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Abstract

Introduction

Knowledge of the association of hemodynamics with progression of septic acute kidney injury (AKI) is limited. However, some recent data suggest that mean arterial pressure (MAP) exceeding current guidelines (60–65 mmHg) may be needed to prevent AKI. We hypothesized that higher MAP during the first 24 hours in the intensive care unit (ICU), would be associated with a lower risk of progression of AKI in patients with severe sepsis.

Methods

We identified 423 patients with severe sepsis and electronically recorded continuous hemodynamic data in the prospective observational FINNAKI study. The primary endpoint was progression of AKI within the first 5 days of ICU admission defined as new onset or worsening of AKI by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We evaluated the association of hemodynamic variables with this endpoint. We included 53724 10-minute medians of MAP in the analysis. We analysed the ability of time-adjusted MAP to predict progression of AKI by receiver operating characteristic (ROC) analysis.

Results

Of 423 patients, 153 (36.2%) had progression of AKI. Patients with progression of AKI had significantly lower time-adjusted MAP, 74.4 mmHg [68.3-80.8], than those without progression, 78.6 mmHg [72.9-85.4], P < 0.001. A cut-off value of 73 mmHg for time-adjusted MAP best predicted the progression of AKI. Chronic kidney disease, higher lactate, higher dose of furosemide, use of dobutamine and time-adjusted MAP below 73 mmHg were independent predictors of progression of AKI.

Conclusions

The findings of this large prospective multicenter observational study suggest that hypotensive episodes (MAP under 73 mmHg) are associated with progression of AKI in critically ill patients with severe sepsis.
Appendix
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Metadata
Title
Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study
Authors
Meri Poukkanen
Erika Wilkman
Suvi T Vaara
Ville Pettilä
Kirsi-Maija Kaukonen
Anna-Maija Korhonen
Ari Uusaro
Seppo Hovilehto
Outi Inkinen
Raili Laru-Sompa
Raku Hautamäki
Anne Kuitunen
Sari Karlsson
the FINNAKI Study Group
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2013
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc13161

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