Association between afterload-related cardiac performance and acute kidney injury in patients with sepsis: a retrospective cohort study

Abstract

BackgroundIt is believed that there is a complex bidirectional causal and pathophysiological relationship between heart and kidney in sepsis. Afterload-related cardiac performance (ACP) has been found to have a close association with cardiac function and prognosis in sepsis. The aim of this study was to explore its correlation with sepsis-associated acute kidney injury (SA-AKI).Methods150 patients with sepsis who underwent PiCCO were included. Restricted cubic spline (RCS) and Cox proportional hazards regression were used to describe the relationship between ACP and SA-AKI. The receiver operating characteristic curve (AUROC) analysis was used to evaluate the predictive value of ACP for SA-AKI. A prediction model of SA-AKI occurrence probability within 7 days was presented by nomogram.Results67.3% patients developed SA-AKI within 7 days. The RCS model demonstrated that the risk of SA-AKI increased with the decrease of ACP. Cox regression analyses also found an independent inverse association between them (HR 0.974, 95%CI 0.963 - 0.985, p < 0.001). ACP showed significantly greater discrimination for SA-AKI than CI (p= 0.004). Independent risk factors for SA-AKI within 7 days were history of hypertension, type of pathogens, SOFA score, serum potassium and ACP. The AUROC of the nomogram established by age and the above factors was 0.865 (95%CI 0.808 – 0.923,p< 0.001) and the C-index was 0.800 (95%CI 0.753 - 0.847).ConclusionsLow ACP was associated with an increased risk of SA-AKI within 7 days. ACP, which might be superior to CI, had the potential for early prediction of SA-AKI.