title: Hemodynamic variables and progression of acute kidney injury in critically ill patients with severe sepsis: data from the prospective observational FINNAKI study.
abstract: BACKGROUND
  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.
authors: Meri
authors: M
authors: Poukkanen
authors: Erika
authors: E
authors: Wilkman
authors: Suvi T
authors: ST
authors: Vaara
authors: Ville
authors: V
authors: Pettilä
authors: Kirsi-Maija
authors: KM
authors: Kaukonen
authors: Anna-Maija
authors: AM
authors: Korhonen
authors: Ari
authors: A
authors: Uusaro
authors: Seppo
authors: S
authors: Hovilehto
authors: Outi
authors: O
authors: Inkinen
authors: Raili
authors: R
authors: Laru-Sompa
authors: Raku
authors: R
authors: Hautamäki
authors: Anne
authors: A
authors: Kuitunen
authors: Sari
authors: S
authors: Karlsson
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000503:physiopathology*; D001794:Blood Pressure; D018450:Disease Progression; D004280:Dobutamine / Q000627:therapeutic use; D005665:Furosemide / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D009638:Norepinephrine / Q000627:therapeutic use; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D004280:Dobutamine; D005665:Furosemide; D009638:Norepinephrine