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Objective To explore the value of renal resistance index (RI) and urine oxygen pressure for early prediction of acute kidney injury (AKI) in patients with septic shock.Methods Patients with septic shock were enrolled from August 2018 to November 2018 in intensive care unit (ICU) at Peking Union Medical College Hospital.Subjects' general information and AKI characteristics were assessed.Area under the receiver operating characteristic (ROC) curve was used to analyze the predictive value of RI,urine oxygen pressure,or combination of RI on the occurrence of AKI.Results A total of 72 septic shock patients were enrolled including 29 patients with AKI and 43 without.Logistic regression analysis of AKI risk factors found that RI (OR=1.139,95％CI 1.029-1.261,P=0.012) and urine oxygen pressure (OR=0.957,95％CI 0.923-0.991,P=0.014) at admission were independent risk factors for AKI in patients with septic shock.The sensitivity and specificity of dual RI and urine oxygen pressure in predicting AKI were 65.5％and 76.7％ respectively (AUCROC 0.772,Youden index 0.423).We selected the cut-off value of RI as 0.70,and urine oxygen pressure as 48 mmHg (1 mmHg=0.133 kPa).According to this two cut-off values patients were divided into four groups,those with RI≥0.70 and urine oxygen pressure≤48 mmHg showed the highest incidence of AKI (75％).There was no statistically difference in 28-day survival rate between the four groups (P=0.197).Conclusion High RI and low urine oxygen pressure are independent risk factors for the development of AKI in patients with septic shock.The predictive cut-off values are 0.70 for RI and 48 mmHg for urine oxygen pressure.Combination of RI and urine oxygen pressure has a practical predictive value for AKI in patients with septic shock.
RESUMO
Objective To evaluate the value of microcirculation and oxygen metabolism evaluation (MicrOME)in acute kidney injury(AKI) evaluation in patients with septic shock after resuscitation. Methods Consecutive patients with septic shock after resuscitation and mechanical ventilation were enrolled from October 2016 to February 2017 in ICU at Peking Union Medical College Hospital.Patients were divided into 3 groups based on 10 min transcutaneous oxygen challenge test transcutaneous partial pressure of oxygen(PtcO2)and venoarterial pressure of carbon dioxide difference(Pv-aCO2)/arteriovenous O2 content difference(Ca-vO2)by blood gas analysis, i.e. group A [ΔPtcO2>66 mmHg(1 mmHg=0.133 kPa) and Pv-aCO2/Ca-vO2≤1.23], group B (ΔPtcO2≤66 mmHg), group C (ΔPtcO2>66 mmHg and Pv-aCO2/Ca-vO2>1.23). Heart rate,mean arterial pressure,central venous pressure,noradrenaline dose,lactate,Pv-aCO2,Ca-vO2, lactate clearance, central venous oxygen saturation(ScvO2) and liquid equilibrium were assessed after resuscitation.AKI staging based on Kidney Disease Global Improving Outcomes (KDIGO) clinical practice guideline was analyzed. The predictive value of lactate,ScvO2,Pv-aCO2/Ca-vO2 to progression of AKI after resuscitation was determined using receiver operating characteristic(ROC)curve analysis.Results A total of 49 septic shock patients were enrolled including 30 males and 19 females with mean age of (61.10±17.10) years old.There were 19 patients in group A,21 patients in group B, and 9 patients in group C. Acute physiology and chronic health evaluation Ⅱ score was 20.92±7.19 and sequential organ failure assessment score 12.02±3.28. There were 4 patients with AKI and 1 progressed in group A,11 patients with AKI and 2 progressed in group B, 6 patients with AKI and 4 progressed in group C. The cutoff value of Pv-aCO2/Ca-vO2 was equal or more than 2.20 for predicting progression of AKI,resulting in a sensitivity of 85.7％ and a specificity of 73.8％.Conclusion MicrOME is a significant parameter to predict the progression of AKI in patients with septic shock after resuscitation. Pv-aCO2/Ca-vO2 is also a good predictive factor.