Increased cardiac index attenuates septic acute kidney injury: a prospective observational study.
BACKGROUND
The relationship between cardiac output and septic acute kidney injury (AKI) remains unclear. The purpose of this study was to assess the association between the cardiac index (CI) and the renal outcomes in patients with septic shock.


METHODS
A one-year prospective cohort study was performed in the surgical and medical ICU of a teaching hospital in Nanjing, China. Twenty-nine septic shock patients who required early goal-directed fluid resuscitation were consecutively included. Pulse indicator continuous cardiac output (PiCCO) device was used to measure hemodynamic parameters before and after early goal-directed therapy (EGDT). Based on CI changes after EGDT, patients were assign to the CI increased group or the CI constant group, respectively. The incidence of poor renal outcome, which was defined as AKI on admission without recovery in following three days or new onset AKI within 28 days, was recorded. We investigated whether an increased CI was associated with a better renal outcome.


RESULTS
After EGDT, there were 16 patients in the CI increased group and 13 patients in the CI constant group. The incidence of poor renal outcome was lower in CI increased group than in the CI constant group (6% vs. 62%; P = 0.003) with a relative risk of 0.10. The logistic regression showed that the CI percent change was associated with renal outcome, with an odd ratio of 0.003 (P = 0.056) after adjustment of possible confounding factors. The CI percent change would predict a good renal outcome (AU ROC 0.739, P = 0.012) with moderate accuracy (sensitivity 75% and specificity 89%) when using a 10% cut-off value from Youden index. The CI percent change was also positively correlated with creatinine clearance (CCr) after EGDT (ρ = 0.548; P = 0.002).


CONCLUSIONS
The increased CI after EGDT was a protective factor for kidney in patients with septic shock. A CI increased above 10% could be potentially used to predict development and reversibility of AKI in septic shock patients.


BACKGROUND
Clinicaltrials.gov:NCT01862588 (May 13, 2013).
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Jing-Chao
JC
Luo
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Xiao-Hua
XH
Qiu
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Chun
C
Pan
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Jian-Feng
JF
Xie
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Tao
T
Yu
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Lin
L
Liu
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Yi
Y
Yang
Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Hai-Bo
HB
Qiu
D058186:Acute Kidney Injury / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output / Q000502:physiology*; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications / Q000628:therapy*
Acute kidney injury; Cardiac index; Septic shock