Value of the combination of renal resistance index and central venous pressure in the early prediction of sepsis-induced acute kidney injury

Song, Jieqiong; Wu, Wei; He, Yizhou Joseph; Sun, Lin; Zhu, Dexiang; Zhong, Ming

doi:10.1016/j.jcrc.2018.03.016

Cited by 39 publications

(22 citation statements)

References 35 publications

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“…The median RRI of 0.80 in patients with AKI in our population must be considered high in comparison but may partly be due to the large proportion of patients with AKI stage 3 at the time of RRI measurement. Notably, patients without AKI in our study had higher RRI (median 0.72) compared to non-AKI patients in ICU populations without COVID-19 where reported values typically are lower than 0.65 [12,14,25]. It is not clear if elevated RRI in patients without AKI but infected with SARS-CoV-2 is a result of the infection itself, or if it re ects severity of illness as indicated by the long length of ICU stay as well as the high incidence of mechanical ventilation and vasopressor use in our population.…”

Section: Discussionmentioning

confidence: 95%

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Renal Resistive Index is Associated With Acute Kidney Injury in COVID-19 Patients Treated in the ICU

Renberg

Jonmarker

Kilhamn

et al. 2020

Preprint

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Background: Renal resistive index (RRI) is a promising tool for prediction of acute kidney injury (AKI) in critically ill patients but is not described among patients with Coronavirus disease 2019 (COVID-19). The aim of this study was to describe the pattern of RRI in relation to AKI in patients with COVID-19 treated in the intensive care unit.Methods: In this observational cohort study, RRI was measured in COVID-19 patients in six ICUs at two sites of a Swedish University Hospital. AKI was defined by the creatinine criteria in the Kidney Disease Improving Global Outcome classification. We investigated the association between RRI and AKI diagnosis, different AKI stages and urine output.Results: RRI was measured in 51 patients, of which 23 patients (45%) had AKI at the time of measurement. Median RRI in patients with AKI was 0.80 (IQR 0.71-0.85) compared to 0.72 (IQR 0.67-0.78) in patients without AKI (p=0.004). Compared to patients without AKI, RRI was higher in patients with AKI stage 3 (median 0.83, IQR 0.71-0.85, p=0.006) but not in patients with AKI stage 1 (median 0.76, IQR 0.71-0.83, p=0.347) or AKI stage 2 (median 0.79, min/max 0.79/0.80, n=2, p=0.134). RRI was higher in patients with an ongoing AKI episode compared to patients who never developed AKI (median 0.72, IQR 0.69-0.78, p=0.015) or patients who developed AKI but had recovered at the time of measurement (median 0.68, IQR 0.67-0.81, p=0.021). Oliguric patients had higher RRI (median 0.84, IQR 0.83-0.85) compared to non-oliguric patients (median 0.74, IQR 0.69-0.81) (p=0.009).Conclusions: Critically ill COVID-19 patients with AKI have higher RRI compared to those without AKI, and elevated RRI may have a role in identifying severe and oliguric AKI in these patients.

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Section: Discussionmentioning

confidence: 95%

“…Previous studies have in general focused on prediction of AKI from RRI measurements performed within the rst day of ICU admission [12,[14][15][16]23]. However, the ability of early RRI measurements to predict short-term AKI reversibility within three days recently has been challenged [32,33].…”

Section: Discussionmentioning

confidence: 99%

Renal Resistive Index is Associated With Acute Kidney Injury in COVID-19 Patients Treated in the ICU

Renberg

Jonmarker

Kilhamn

et al. 2020

Preprint

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“…Resistive index (RI) is a parameter that not only indicates the absolute value of blood flow velocity but also reflects changes in Doppler waveforms [7] .Previous studies have shown that it has mainly been to evaluate blood flow to a target organ.The combination of renal RI and CVP was valuable in the early prediction for sepsis-induced AKI [20] . Lindsay R Clark et al found that index of cerebrovascular resistance is a potential vascular biomarker and it suggest that regionally-specific vascular changes may contribute to cognitive decline, particularly in the very-old [21] .But, RI can also associate with hemodynamics [9] .If RI could be used simply to quantify peripheral blood vessel resistance, based on a different perspective from that of cardiac output and oxygen saturation of mixed-venous blood,it could be an important parameter for circulation control.Because the waveforms obtained by the Doppler method are influenced by the angle between the ultrasound beam and blood flow direction,the incidence angle is critical in the Doppler analysis of blood flow, and an angle smaller than 60° is required to reduce the error to less than 20%.…”

Section: Discussionmentioning

confidence: 99%

Association Between Doppler Snuffbox Resistive Index and Tissue Perfusion in Septic Patients

Wang

Zhang

et al. 2020

Shock

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Background: Peripheral vascular disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in septic shock. The Doppler snuffbox resistive index (SBRI) can be an accurate parameter to evaluate the status of peripheral vasculature at the bedside. We evaluated whether the SBRI is related to lactate levels or the peripheral perfusion index (PI) and its ability to predict lactate clearance in septic patients. Methods: We conducted a prospective observational study in a tertiary general and teaching hospital in China. From July 2019 to December 2019, all consecutive adult patients with septic shock who required intensive care unit admission were included. At the same time, 20 stable postoperative patients were studied as a control group. We recorded the hemodynamic parameters, including the SBRI and PI, which were measured simultaneously after patient recruitment. Results: We evaluated 44 patients with septic shock in the study group and 20 stable postoperative patients in the control group. Patients with septic shock had higher Sequential Organ Failure Assessment scores, procalcitonin levels, cardiac index (CI) and lactate levels than patients in the control group. The SBRI was correlated with the PI and lactate level. The CI was not correlated with lactate level in the patients examined. Based on lactate clearance in the first 6 h, the septic shock patients were divided into two groups: one with lactate clearance ≥20% (n = 28) and the other with lactate clearance <20% (n = 16). The CI was not significantly different between the two groups. The SBRI of the lactate clearance <20% group was higher than that of the lactate clearance ≥20% group and the control group. The PI of the lactate clearance <20% group was lower than that of the lactate clearance ≥20% group and the control group. The SBRI cutoff value for predicting 6-h lactate clearance after resuscitation was ≥1.09, with a sensitivity of 68.8% and a specificity of 85.7%. The PI cutoff value for predicting 6-h lactate clearance after resuscitation was ≤0.99, with a sensitivity of 64.3% and a specificity of 81.2%. The SBRI was significantly better than the PI for predicting 6-h lactate clearance after resuscitation (area under the curve: 0.805 vs. 0.703, P < 0.05). Conclusions: The Doppler SBRI is correlated with tissue perfusion parameters in critically ill patients. An abnormal SBRI may be better than the PI for predicting poor lactate clearance in septic patients. Further investigations are required to determine whether correcting an abnormal SBRI and PI may improve the success rate of septic shock resuscitation.

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“…For example, multivariate regression analysis has been used to retrospectively identify independent predictors of sepsis-associated AKI, which included demographic parameters such as age and clinical risk factors such as hypotension 97 . In another study, the combination of high central venous pressure and elevated renal resistive indices, as measured by ultrasound in patients with sepsis, was found to be a sensitive, early predictor of sepsis-associated AKI 95 . More recently, a pilot study combining sequential organ failure assessment scores and biomarker measurements (specifically, serum and urine NGAL) demonstrated the ability to predict AKI and mortality with good sensitivity and specificity 96 .…”

Section: Enrichment In Sepsis-associated Akimentioning

confidence: 94%

“…To date, few successful enrichment strategies have been proposed for the prediction of sepsis-associated AKI. Although the data remain sparse, existing attempts have utilized single biomarkers [85][86][87][88][89][90][91][92] , panels of known biomarkers 93 , microarray for the identification of novel candidate biomarkers 94 and clinical parameters [95][96][97] for AKI prediction and prognostic enrichment.…”

Section: Enrichment In Sepsis-associated Akimentioning

confidence: 99%

Prognostic and predictive enrichment in sepsis

2019

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Value of the combination of renal resistance index and central venous pressure in the early prediction of sepsis-induced acute kidney injury

Cited by 39 publications

References 35 publications

Renal Resistive Index is Associated With Acute Kidney Injury in COVID-19 Patients Treated in the ICU

Renal Resistive Index is Associated With Acute Kidney Injury in COVID-19 Patients Treated in the ICU

Association Between Doppler Snuffbox Resistive Index and Tissue Perfusion in Septic Patients

Prognostic and predictive enrichment in sepsis

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