title: Low Systemic Oxygen Delivery and BP and Risk of Progression of Early AKI.
abstract: OBJECTIVE
  The optimal hemodynamic management of patients with early AKI is unknown. This study aimed to investigate the association between hemodynamic parameters in early AKI and progression to severe AKI and hospital mortality.
  
  
  METHODS
  This study retrospectively analyzed the data of all patients admitted to the adult intensive care unit in a tertiary care center between July 2007 and June 2009 and identified those with stage 1 AKI (AKI I) per the AKI Network classification. In patients in whom hemodynamic monitoring was performed within 12 hours of AKI I, hemodynamic parameters in the first 12 hours of AKI I and on the day of AKI III (if AKI III developed) or 72 hours after AKI I (if AKI III did not develop) were recorded. Risk factors for AKI III and mortality were identified using univariate and multivariate logistic regression analyses.
  
  
  RESULTS
  Among 790 patients with AKI I, 210 (median age 70 years; 138 men) had hemodynamic monitoring within 12 hours of AKI I; 85 patients (41.5%) progressed to AKI III and 91 (43%) died in the hospital. AKI progressors had a significantly higher Sequential Organ Failure Assessment score (8.0 versus 9.6; P<0.001), lower indexed systemic oxygen delivery (DO2I) (median 325 versus 405 ml/min per m(2); P<0.001), higher central venous pressure (16 versus 13; P=0.02), and lower mean arterial blood pressure (MAP) (median 71 versus 74 mmHg; P=0.01) in the first 12 hours of AKI I compared with nonprogressors. Multivariate analysis confirmed that raised lactate, central venous pressure, and Sequential Organ Failure Assessment score as well as mechanical ventilation were independently associated with progression to AKI III; higher DO2I and MAP were independently associated with a lower risk of AKI III but not survival. The associations were independent of sepsis, heart disease, recent cardiac surgery, or chronic hypertension.
  
  
  CONCLUSIONS
  Higher DO2I and MAP in early AKI were independently associated with a lower risk of progression.
authors.affiliation: Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom; Santa Maria Hospital, North Lisbon Hospital Center, Lisbon, Portugal; and.
authors.forename: Mario
authors.initials: M
authors.lastname: Raimundo
authors.affiliation: Division of Health and Social Care Research, King's College London, London, United Kingdom.
authors.forename: Siobhan
authors.initials: S
authors.lastname: Crichton
authors.affiliation: Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom;
authors.forename: Yadullah
authors.initials: Y
authors.lastname: Syed
authors.affiliation: Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom;
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Martin
authors.affiliation: Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom;
authors.forename: Richard
authors.initials: R
authors.lastname: Beale
authors.affiliation: Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom;
authors.forename: David
authors.initials: D
authors.lastname: Treacher
authors.affiliation: Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Hospital, London, United Kingdom; marlies.ostermann@gstt.nhs.uk.
authors.forename: Marlies
authors.initials: M
authors.lastname: Ostermann
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D000368:Aged; D062186:Arterial Pressure; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D063305:Organ Dysfunction Scores; D010100:Oxygen / Q000097:blood*; D011237:Predictive Value of Tests; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010100:Oxygen
keywords: ARF; hypotension; kidney failure; mortality risk