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Increased cardiac index attenuates septic acute kidney injury: a prospective observational study
Jing-Chao Luo1, Xiao-Hua Qiu1, Chun Pan1
1Department of Critical Care Medicine, Zhong-Da Hospital, Southeast University School of Medicine, Nanjing, China.
Insights
Increasing cardiac index (CI) after early goal-directed therapy (EGDT) protects kidneys in septic shock patients. A CI increase over 10% may predict acute kidney injury (AKI) development and recovery.
Area of Science:
- Critical Care Medicine
- Nephrology
- Hemodynamics
Background:
- The association between cardiac output and septic acute kidney injury (AKI) is not well understood.
- Septic shock poses a significant risk for developing AKI, impacting patient outcomes.
- Early identification of factors influencing renal outcomes in septic shock is crucial.
Purpose of the Study:
- To evaluate the relationship between cardiac index (CI) and renal outcomes in patients with septic shock.
- To determine if an increase in CI following early goal-directed therapy (EGDT) is associated with improved kidney function.
- To explore the predictive value of CI changes for AKI development and reversibility.
Main Methods:
- A prospective cohort study involving 29 septic shock patients requiring EGDT.
- Hemodynamic parameters, including CI, were measured using a PiCCO device before and after EGDT.
- Patients were categorized into groups based on CI changes post-EGDT; renal outcomes were recorded and analyzed.
Main Results:
- A significantly lower incidence of poor renal outcome was observed in the CI increased group compared to the CI constant group (6% vs. 62%, P=0.003).
- A CI increase of 10% post-EGDT demonstrated moderate accuracy in predicting good renal outcome (AU ROC 0.739).
- CI percent change positively correlated with creatinine clearance (CCr) post-EGDT (ρ=0.548, P=0.002).
Conclusions:
- Increased CI after EGDT acts as a protective factor for kidney function in septic shock.
- A CI increase exceeding 10% may serve as a potential predictor for AKI development and reversibility in septic shock patients.
- Hemodynamic optimization, specifically increasing CI, is vital for renal protection in septic shock management.
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.
Trial Registration:
Clinicaltrials.gov:NCT01862588 (May 13, 2013).
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