title: Mean arterial pressure and mean perfusion pressure deficit in septic acute kidney injury.
abstract: BACKGROUND
  Changes in mean perfusion pressure (MPP) from premorbid resting values may contribute to the progression of septic acute kidney injury (AKI).
  
  
  OBJECTIVE
  In patients with septic shock, we aimed to investigate the association of changes from premorbid values with AKI severity and progression.
  
  
  METHODS
  We obtained premorbid resting mean arterial pressure (MAP), central venous pressure (CVP), and MPP, and then recorded data from intensive care unit admission 2 hourly for the first 24 hours to calculate hemodynamic deficits. We recorded 4-hourly creatinine measurements for 96 hours. The association of hemodynamic variables with progression of AKI by Kidney Disease: Improving Global Outcomes ≥2 stages was explored by multivariate logistic regression.
  
  
  RESULTS
  Of 107 patients, 55 (51.4%) had severe AKI. Median MAP deficit was similar for patients with or without severe AKI. Median MPP deficit was 29% in patients with severe AKI and 24% in those without (P = .04), a difference determined by greater CVP levels. Central venous pressure was independently associated with worsening AKI (odds ratio, 1.26 [95% confidence interval, 1.01-1.58]; P = .04).
  
  
  CONCLUSIONS
  Mean arterial pressure and MPP deficits were substantial in septic shock patients, with patients with severe AKI having a greater MPP deficit. However, only CVP was independently associated with AKI progression. These findings suggest a possible role for venous congestion in septic AKI.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Wong
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Chan
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: neil.glassford@austin.org.au.
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Glassford
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Section of Anaesthesia Intensive Care Medicine, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Mårtensson
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bion
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Syn Y
authors.initials: SY
authors.lastname: Chai
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Chad
authors.initials: C
authors.lastname: Oughton
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Isabela Y
authors.initials: IY
authors.lastname: Tsuji
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
authors.forename: Cristina Lluch
authors.initials: CL
authors.lastname: Candal
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia; Australian and New Zealand Intensive Care Research Centre and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D000368:Aged; D062186:Arterial Pressure; D002496:Central Venous Pressure; D003404:Creatinine / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007677:Kidney Function Tests / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D015996:Survival Rate
chemical_list: D003404:Creatinine
keywords: Acute kidney injury; Central venous pressure; Critical care; Hemodynamic targets; Mean perfusion pressure; Resuscitation