Impact of individualized target mean arterial pressure for septic shock resuscitation on the incidence of acute kidney injury: a retrospective cohort study

Abstract

Abstract Background To examine the relationship between delta mean arterial pressure (ΔMAP; MAP change between pre-admission minus post-resuscitation) and acute kidney injury (AKI) among patients with septic shock. In this retrospective, single-center cohort study of adult patients pre-admission MAP is defined as the median MAP recorded from 365 to 7 days before admission. Post-resuscitation MAP was median MAP during the 7th hour after initiating resuscitation. Results In our cohort (N = 233; 55% male), the median (interquartile range [IQR]) age was 71 (58–81) years and the median (IQR) acute physiology, age, chronic health evaluation (APACHE) III score was 81 (66–97). Although those in the lowest ΔMAP quartile (−24.5 to 3.9 mmHg) had no demographic differences compared with the rest of the cohort, the odds ratio for AKI was 0.26 (95% CI 0.11–0.57) after adjustment for other known AKI risk factors. Among patients with a history of hypertension, the lowest quartile had an odds ratio for AKI of 0.12 (95% CI 0.04–0.37) after adjusting for risk factors for AKI in this cohort. Conclusions The incidence of AKI was lowest among those whose post-resuscitation MAP was closest to or higher than their pre-admission MAP. Further study regarding the effect of targeting the pre-admission MAP for post-resuscitation on the incidence of AKI is warranted.

Keywords

• Blood pressure target
• Early goal-directed therapy
• Fluid resuscitation
• Hypertension
• Severe sepsis