Elevated central venous pressure is associated with increased mortality and acute kidney injury in critically ill patients: a meta-analysis

Abstract

Background: The association of central venous pressure (CVP) and mortality and acute kidney injury (AKI) in critically ill adult patients remains unclear. We performed a meta-analysis to determine whether elevated CVP is associated with increased mortality and AKI in critically ill adult patients. Methods: We searched PubMed and Embase through June 2019 to identify studies that investigated the association between CVP and mortality and/or AKI in critically ill adult patients admitted into the intensive care unit. We calculated the summary odds ratio (OR) and 95% CI using a random-effects model. Results: Fifteen cohort studies with a broad spectrum of critically ill patients (mainly sepsis) were included. On a dichotomous scale, elevated CVP was associated with an increased risk of mortality (3 studies; 969 participants; OR, 1.65; 95% CI, 1.19-2.29) and AKI (2 studies; 689 participants; OR, 2.09; 95% CI, 1.39-3.14). On a continuous scale, higher CVP was associated with greater risk of mortality (5 studies; 7837 participants; OR, 1.10; 95% CI, 1.03-1.17) and AKI (6 studies; 5446 participants; OR, 1.14; 95% CI, 1.06-1.23). Furthermore, per 1 mmHg increase in CVP increased the odds of AKI by 6% (4 studies; 5150 participants; OR, 1.06; 95% CI, 1.01-1.12). Further analyses restricted to patients with sepsis showed consistent results. Conclusions: Elevated CVP is associated with an increased risk of mortality and AKI in critically ill adult patients admitted into the intensive care unit.

Association Between Early Central Venous Pressure Measurement and Mortality in Patients With Sepsis: A Retrospective Study

“…Therefore, clinicians should not only further look into cardiac function or intravascular volume, but also the possible impact of venous congestion on upstream organs. The association between elevated CVP and kidney dysfunction has also been found in critically ill patients [18,20,21]. In the perspective of venous return function, under the premise of maintaining adequate tissue perfusion, CVP should be maintained as low as possible to allow an adequate venous return, and thus to increase CO (in a steady condition, CO must equal venous return) and reduce tissue edema.…”

“…Patients are at higher risk of mortality if hypovolemia is inadequately resuscitated [4]. The association between elevated CVP and increased mortality has been found by numerous studies [14][15][16][17][18][19]. Besides, since CVP serves as the backpressure of venous return, upstream capillary pressures must be even higher in the setting of increased CVP to maintain an intact venous return.…”

Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States

“…Finally, congestive heart failure was also a risk factor for acute kidney injury. Both the decreased cardiac output and the elevation of systemic venous pressure resulting from congestive heart failure led to renal hypoperfusion and acute kidney injury [27].…”

Associations between mean systemic filling pressure and acute kidney injury: An observational cohort study following cardiac surgery

“…A similar threshold value was found in this study using CVP recorded during the first 48 hours. A cohort study using the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC‐II) database 30 and a recent meta‐analysis 31 reported a 2%‐6% increased risk for AKI for each unit increase in CVP. The association between venous congestion as suggested by increased CVP and AKI is thus supported by observational evidence.…”