Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study

<i>Background and Objectives:</i> In the intensive care unit (ICU), renal failure and respiratory failure are two of the most common organ failures in patients with systemic inflammatory response syndrome (SIRS). These clinical symptoms usually result from sepsis, trauma, hypermetabolism...

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Autores principales:	Chi-Hua Ko, Ying-Wei Lan, Ying-Chou Chen, Tien-Tsai Cheng, Shan-Fu Yu, Abdulkadir Cidem, Yu-Hsien Liu, Chia-Wen Kuo, Chih-Ching Yen, Wei Chen, Chuan-Mu Chen
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	acute kidney injury (AKI) acute hypoxic respiratory failure (AHRF) mean arterial pressure (MAP) blood pH lactate Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/a8f6df94b60849349624a193604f971e
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spelling	oai:doaj.org-article:a8f6df94b60849349624a193604f971e2021-11-25T18:18:54ZEffects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study10.3390/medicina571112431648-91441010-660Xhttps://doaj.org/article/a8f6df94b60849349624a193604f971e2021-11-01T00:00:00Zhttps://www.mdpi.com/1648-9144/57/11/1243https://doaj.org/toc/1010-660Xhttps://doaj.org/toc/1648-9144<i>Background and Objectives:</i> In the intensive care unit (ICU), renal failure and respiratory failure are two of the most common organ failures in patients with systemic inflammatory response syndrome (SIRS). These clinical symptoms usually result from sepsis, trauma, hypermetabolism or shock. If this syndrome is caused by septic shock, the Surviving Sepsis Campaign Bundle suggests that vasopressin be given to maintain mean arterial pressure (MAP) > 65 mmHg if the patient is hypotensive after fluid resuscitation. Nevertheless, it is important to note that some studies found an effect of various mean arterial pressures on organ function; for example, a MAP of less than 75 mmHg was associated with the risk of acute kidney injury (AKI). However, no published study has evaluated the risk factors of mortality in the subgroup of acute kidney injury with respiratory failure, and little is known of the impact of general risk factors that may increase the mortality rate. <i>Materials and Methods:</i> The objective of this study was to determine the risk factors that might directly affect survival in critically ill patients with multiple organ failure in this subgroup. We retrospectively constructed a cohort study of patients who were admitted to the ICUs, including medical, surgical, and neurological, over 24 months (2015.1 to 2016.12) at Chiayi Chang Gung Memorial Hospital. We only considered patients who met the criteria of acute renal injury according to the Acute Kidney Injury Network (AKIN) and were undergoing mechanical ventilator support due to acute respiratory failure at admission. <i>Results:</i> Data showed that the overall ICU and hospital mortality rate was 63.5%. The most common cause of ICU admission in this cohort study was cardiovascular disease (31.7%) followed by respiratory disease (28.6%). Most patients (73%) suffered sepsis during their ICU admission and the mean length of hospital stay was 24.32 ± 25.73 days. In general, the factors independently associated with in-hospital mortality were lactate > 51.8 mg/dL, MAP ≤ 77.16 mmHg, and pH ≤ 7.22. The risk of in-patient mortality was analyzed using a multivariable Cox regression survival model. Adjusting for other covariates, MAP ≤ 77.16 mmHg was associated with higher probability of in-hospital death [OR = 3.06 (1.374–6.853), <i>p</i> = 0.006]. The other independent outcome predictor of mortality was pH ≤ 7.22 [OR = 2.40 (1.122–5.147), <i>p</i> = 0.024]. Kaplan-Meier survival curves were calculated and the log rank statistic was highly significant. <i>Conclusions:</i> Acute kidney injury combined with respiratory failure is associated with high mortality. High mean arterial pressure and normal blood pH might improve these outcomes. Therefore, the acid–base status and MAP should be considered when attempting to predict outcome. Moreover, the blood pressure targets for acute kidney injury in critical care should not be similar to those recommended for the general population and might prevent mortality.Chi-Hua KoYing-Wei LanYing-Chou ChenTien-Tsai ChengShan-Fu YuAbdulkadir CidemYu-Hsien LiuChia-Wen KuoChih-Ching YenWei ChenChuan-Mu ChenMDPI AGarticleacute kidney injury (AKI)acute hypoxic respiratory failure (AHRF)mean arterial pressure (MAP)blood pHlactateMedicine (General)R5-920ENMedicina, Vol 57, Iss 1243, p 1243 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute kidney injury (AKI) acute hypoxic respiratory failure (AHRF) mean arterial pressure (MAP) blood pH lactate Medicine (General) R5-920
spellingShingle	acute kidney injury (AKI) acute hypoxic respiratory failure (AHRF) mean arterial pressure (MAP) blood pH lactate Medicine (General) R5-920 Chi-Hua Ko Ying-Wei Lan Ying-Chou Chen Tien-Tsai Cheng Shan-Fu Yu Abdulkadir Cidem Yu-Hsien Liu Chia-Wen Kuo Chih-Ching Yen Wei Chen Chuan-Mu Chen Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study
description	<i>Background and Objectives:</i> In the intensive care unit (ICU), renal failure and respiratory failure are two of the most common organ failures in patients with systemic inflammatory response syndrome (SIRS). These clinical symptoms usually result from sepsis, trauma, hypermetabolism or shock. If this syndrome is caused by septic shock, the Surviving Sepsis Campaign Bundle suggests that vasopressin be given to maintain mean arterial pressure (MAP) > 65 mmHg if the patient is hypotensive after fluid resuscitation. Nevertheless, it is important to note that some studies found an effect of various mean arterial pressures on organ function; for example, a MAP of less than 75 mmHg was associated with the risk of acute kidney injury (AKI). However, no published study has evaluated the risk factors of mortality in the subgroup of acute kidney injury with respiratory failure, and little is known of the impact of general risk factors that may increase the mortality rate. <i>Materials and Methods:</i> The objective of this study was to determine the risk factors that might directly affect survival in critically ill patients with multiple organ failure in this subgroup. We retrospectively constructed a cohort study of patients who were admitted to the ICUs, including medical, surgical, and neurological, over 24 months (2015.1 to 2016.12) at Chiayi Chang Gung Memorial Hospital. We only considered patients who met the criteria of acute renal injury according to the Acute Kidney Injury Network (AKIN) and were undergoing mechanical ventilator support due to acute respiratory failure at admission. <i>Results:</i> Data showed that the overall ICU and hospital mortality rate was 63.5%. The most common cause of ICU admission in this cohort study was cardiovascular disease (31.7%) followed by respiratory disease (28.6%). Most patients (73%) suffered sepsis during their ICU admission and the mean length of hospital stay was 24.32 ± 25.73 days. In general, the factors independently associated with in-hospital mortality were lactate > 51.8 mg/dL, MAP ≤ 77.16 mmHg, and pH ≤ 7.22. The risk of in-patient mortality was analyzed using a multivariable Cox regression survival model. Adjusting for other covariates, MAP ≤ 77.16 mmHg was associated with higher probability of in-hospital death [OR = 3.06 (1.374–6.853), <i>p</i> = 0.006]. The other independent outcome predictor of mortality was pH ≤ 7.22 [OR = 2.40 (1.122–5.147), <i>p</i> = 0.024]. Kaplan-Meier survival curves were calculated and the log rank statistic was highly significant. <i>Conclusions:</i> Acute kidney injury combined with respiratory failure is associated with high mortality. High mean arterial pressure and normal blood pH might improve these outcomes. Therefore, the acid–base status and MAP should be considered when attempting to predict outcome. Moreover, the blood pressure targets for acute kidney injury in critical care should not be similar to those recommended for the general population and might prevent mortality.
format	article
author	Chi-Hua Ko Ying-Wei Lan Ying-Chou Chen Tien-Tsai Cheng Shan-Fu Yu Abdulkadir Cidem Yu-Hsien Liu Chia-Wen Kuo Chih-Ching Yen Wei Chen Chuan-Mu Chen
author_facet	Chi-Hua Ko Ying-Wei Lan Ying-Chou Chen Tien-Tsai Cheng Shan-Fu Yu Abdulkadir Cidem Yu-Hsien Liu Chia-Wen Kuo Chih-Ching Yen Wei Chen Chuan-Mu Chen
author_sort	Chi-Hua Ko
title	Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study
title_short	Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study
title_full	Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study
title_fullStr	Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study
title_full_unstemmed	Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study
title_sort	effects of mean artery pressure and blood ph on survival rate of patients with acute kidney injury combined with acute hypoxic respiratory failure: a retrospective study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/a8f6df94b60849349624a193604f971e
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Effects of Mean Artery Pressure and Blood pH on Survival Rate of Patients with Acute Kidney Injury Combined with Acute Hypoxic Respiratory Failure: A Retrospective Study

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