Decreased Renal Cortical Perfusion Post-EGDT in Sepsis: Implications for MAKE-30 and the Influential Role of CVP

Abstract

Objective: Renal perfusion during sepsis remains a relatively unexplored area. This study aims to delve into alterations in renal cortical perfusion following Early Goal-Directed Therapy (EGDT) in patients with sepsis. We investigate its implications on major adverse kidney events within 30 days (MAKE-30) and endeavor to pinpoint hemodynamic factors that influence renal cortical perfusion. Methods: We prospectively enrolled sepsis patients admitted to the intensive care unit from January 2022 to July 2023. After EGDT, contrast-enhanced ultrasound (CEUS) was used to assess cortical renal perfusion. Hemodynamic parameters, including cardiac index (CI) and mean arterial pressure (MAP) as indicators of renal forward perfusion, central venous pressure (CVP), oxygen metabolism parameters (SvO2 - mixed venous oxygen saturation, and Gapv-aCO2 - venous-arterial carbon dioxide gradient, lactate levels), and renal resistive index (RRI), were systematically collected from the patients.Patients were divided into major adverse kidney events within 30 days (MAKE-30) and non-major adverse kidney events within 30 days (non-MAKE-30) groups. The study scrutinized the influence of renal cortical perfusion on MAKE-30 and elucidated the hemodynamic determinants affecting cortical perfusion. Results: The study included 65 sepsis patients, with 31 patients (47.7%) experiencing MAKE-30 (including 11 deaths, 25 with creatinine elevation exceeding baseline by 200%, and 11 undergoing renal replacement therapy). The remaining 34 patients had no-MAKE-30. A noteworthy distinction in abdominal infection sites was observed between the two groups (P=0.009). Significant differences in SOFA and APACHE II scores were also noted (P=0.001 and 0.004, respectively). Additional baseline characteristics (such as vasopressor doses and diuretic doses) showed no significant differences (P>0.05). In sepsis patients MAKE-30 and non-MAKE-30, hemodynamic parameters including MAP, CI, CVP, and lactate showed no significant differences (p=0.662, p=0.754, p=0.353) and were within the normal range. RRI was significantly higher in sepsis patients with MAKE-30(p=0.001). Parameters of renal microcirculation perfusion, including area under the curve (AUC) (p=0.048), along with relative blood volume (rBV) (p=0.013) and perfusion index (PI) (p=0.008), were significantly lower in MAKE-30 patients, while RT(RT≥16.92) was significantly prolonged. sepsis patients with reduced cortical renal perfusion had an increased risk of MAKE-30. Renal cortical perfusion Rise time(RT) was identified as an independent influencing factor for MAKE-30 (HR 1.092, 95% CI 1.017–1.173, P=0.015). CVP showed correlations with renal cortical perfusion RT and PI (correlation coefficients r were -0.29 and 0.273, p<0.05). Conclusion: Despite normal systemic hemodynamic indicators after sepsis EGDT, MAKE-30 patients exhibit reduced renal cortical perfusion, and CEUS-derived renal cortical perfusion parameter RT is an independent influencing factor. Renal cortical perfusion and CVP are significantly correlated, and CVP may be a simple and easily obtainable indicators to reflect renal cortical perfusion in sepsis patients.