Effects of central venous pressure trajectories on the risk of acute kidney injury in patients with severe sepsis
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Background
Recent years, the trajectory models enable clinicians to explore longitudinal data. Previous studies had found that high central venous pressure (CVP) exposure significantly increase acute kidney injury (AKI). However, no literature had revealed the association between CVP trajectories and AKI occurrence in septic patients. This study aims to investigate the dynamic evolution of CVP and its association with AKI development.
Methods
This was a retrospective observational cohort study using data collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) , an open-source clinical database. Severe septic adult patients with CVP measurements and subsequently diagnosed with AKI were included. Group based trajectory model (GBTM) was used to derive heterogeneous CVP trajectories and analyze the AKI rate in each trajectory. Univariable and multivariate logistic regression was used to detect the association between variables and outcome.
Results
A total of 1372 patients were enrolled in our study. Three trajectories were identified in the results: the consistently moderate and stable CVP class (Class 1), the class with an elevation trend and then mild decline but stay persistently high level (Class 2), and the transient mild decline precedes sustained increase class (Class 3). These classes showed differences in AKI rate. Class 1 had the lowest rate (63.15%), Class 2 the highest (92.10%), and Class 3 was intermediate (86.05%) (p<0.001). After model adjustment, Class 2 continued to possess the highest risk (p<0.001). The baseline characteristics of age (OR=1.02, 95%CI=1.01–1.02) and BMI (OR=1.06, 95%CI=1.04–1.07) are risk factors of AKI.
Conclusions
Patients with persistently high CVP and those with transient mild decline precedes sustained increase of CVP had a greater risk of developing AKI than patients with consistently moderate and stable level. The different trajectories of CVP could provide risk markers for adverse events of AKI.
