The clinical significance of microcirculation and oxygen metabolism evaluation in acute kidney injury assessment in patients with septic shock after resuscitation / 中华内科杂志

ABSTRACT

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.