Renal Resistive Index: Response to Shock and its Determinants in Critically Ill Patients

Rozemeijer, Sander; Mulier, Jelle L G Haitsma; Röttgering, Jantine Geertruida; Elbers, Paul; Man, A.M.E. Spoelstra-de; Tuinman, Pieter R.; Waard, Monique C. de; Straaten, Heleen M. Oudemans–van

doi:10.1097/shk.0000000000001246

Cited by 32 publications

(24 citation statements)

References 33 publications

(47 reference statements)

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“…This nding supports the hypothesis that under conditions of tissue hypoperfusion, the renal vasculature can early respond to an oxygen supply and demand mismatch by modulating the vascular tone. Furthermore, it is indirectly consistent with the ndings of a recent study demonstrating RRI of patients admitted with shock was higher than RRI in patients without shock [13]. Likewise, a similar relationship between RRI and shock was also observed in the present study.…”

Section: Discussionsupporting

confidence: 94%

“…Due to lack of data regarding the association between RRI and P (cv-a) CO 2 /C (a-cv) O 2 ratio, we estimated the sample size as follows: Based on data provided by Rozemeijer et al (13), we first considered a correlation coefficient of 0.28 between RRI and arterial lactate; given a power of 0.80 and a significance level of 5%, a total sample of 97 patients was required. Furthermore, we considered an estimated mean RRI of 0.681 in the lactate < 3 mmol/L patients and an RRI of 0.727 in the lactate ≥ 3 mmol/L patients with a standard deviation of 0.081.…”

Section: Methodsmentioning

confidence: 99%

“…Occurrence of AKI was assessed within 7 days after ICU admission. An RRI value of 0.70 was considered to be the upper threshold of the normal RRI as previously proposed (1,10,13,28). P (cv-a) CO 2 / C (a-cv) O 2 ratio and arterial lactate were used as global tissue hypoperfusion indices.…”

Section: Definitionsmentioning

confidence: 99%

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Renal Resistive Index on Intensive Care Unit Admission Correlates With Tissue Hypoperfusion Indices and Predicts Clinical Outcome

Fotopoulou

Poularas

Kokkoris

et al. 2021

Shock

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Background: Recent advancements in the context of shock pathophysiology, support ultrasound assessment of organ perfusion. Renal resistive index (RRI) has been used to evaluate renal blood ow.Our aim was to investigate the relation between RRI, and global tissue hypoperfusion indices, in mechanically ventilated critically ill patients and their association with clinical outcome. Methods: In this prospective observational study, RRI was measured within 24 hours of intensive care unit (ICU) admission. Clinical and laboratory data, routine hemodynamic variables and gas exchange at the time of RRI assessment were recorded. The ratio of central venous-to-arterial carbon dioxide partial pressure difference by arterial-to-central venous oxygen content difference (P (cv-a) CO 2 /C (a-cv) O 2 ) and lactate were used as global tissue hypoperfusion indices.Results A total of 126 mechanically ventilated patients were included [median age 61 (IQR 28) years, 74% males]. Seventy-seven patients had RRI values >0.7. P (cv-a) CO 2 /C (a-cv) O 2 ratio and arterial lactate, were signi cantly higher in patients with RRI > 0.7 compared to those with RRI ≤0.7 [2.4 (2.2) versus 1.2 (0.6) and 2.88 (3.39) versus 0.62 (0.57) mmol/l respectively, both p<0.001)]. RRI was signi cantly correlated with P (cv-a) CO 2 /C (a-cv) O 2 ratio and arterial lactate for the whole patient population (rho=0.64, both p<0.0001) as well as for the subset of patients with shock (rho=0.47, p=0.001; and r=0.64, p<0.0001 respectively).All-cause ICU mortality was 27.8%. Compared to survivors, ICU non-survivors had a higher RRI [0.80 (0.10) versus 0.70 (0.10), p<0.001] and higher P(cv-a)CO 2 / C(a-cv)O 2 ratio [3.67 (3.8) versus 0.91 (1.4)] and lactate levels [2.80 (2.00) versus 1.50 (1.20)], both p <0.001). Logistic regression models showed a signi cant association between RRI and P (cv-a) CO 2 /C (a-cv) O 2 ratio with clinical outcome. RRI showed good ability to predict ICU mortality (AUC 74.9% (95% CI 61% -88.8%). The combination of RRI with P (cva) CO 2 )/(C (a-cv) O 2 ratio and lactate better predicted mortality than RRI alone [AUC 84.8% (95% CI 5.1% -94.4%)] versus 0.74.9%, respectively, p<0.001).Conclusions: In mechanically ventilated patients, renal blood ow impairment, assessed by the RRI on ICU admission, correlates with global tissue hypoperfusion indices. In addition, RRI in combination with tissue perfusion estimation is more valuable in predicting clinical outcome than RRI alone.

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Section: Discussionsupporting

confidence: 94%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Renal Resistive Index on Intensive Care Unit Admission Correlates With Tissue Hypoperfusion Indices and Predicts Clinical Outcome

Fotopoulou

Poularas

Kokkoris

et al. 2021

Shock

View full text Add to dashboard Cite

show abstract

“…This nding supports the hypothesis that under conditions of tissue hypoperfusion, the renal vasculature can early respond to an oxygen supply and demand mismatch by modulating the vascular tone. Furthermore, it is indirectly consistent with the ndings of a recent study demonstrating that RRI of patients admitted with shock was higher than RRI in patients without shock [13]. Likewise, a similar relationship between RRI and shock was also observed in the present study.…”

Section: Discussionsupporting

confidence: 93%

Renal Resistive Index on Intensive Care Unit Admission Correlates with Tissue Hypoperfusion Indices and Predicts Clinical Outcome

Fotopoulou¹,

Poularas²,

Kokkoris³

et al. 2021

Preprint

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Background: Recent advancements in the context of shock pathophysiology, support ultrasound assessment of organ perfusion. Renal resistive index (RRI) has been used to evaluate renal blood flow. Our aim was to investigate the relation between RRI, and global tissue hypoperfusion indices, in mechanically ventilated critically ill patients and their association with clinical outcome.Methods: In this prospective observational study, RRI was measured within 24 hours of intensive care unit (ICU) admission. Clinical and laboratory data, routine hemodynamic variables and gas exchange at the time of RRI assessment were recorded. The ratio of central venous-to-arterial carbon dioxide partial pressure difference by arterial-to-central venous oxygen content difference (P(cv-a)CO2/C(a-cv)O2) and lactate were used as global tissue hypoperfusion indices. Results A total of 126 mechanically ventilated patients were included [median age 61 (IQR 28) years, 74% males]. Seventy-seven patients had RRI values >0.7. P(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate, were significantly higher in patients with RRI > 0.7 compared to those with RRI ≤0.7 [2.4 (2.2) versus 1.2 (0.6) and 2.88 (3.39) versus 0.62 (0.57) mmol/l respectively, both p<0.001)]. RRI was significantly correlated with P(cv-a)CO2/C(a-cv)O2 ratio and arterial lactate for the whole patient population (rho=0.64, both p<0.0001) as well as for the subset of patients with shock (rho=0.47, p=0.001; and r=0.64, p<0.0001 respectively).All-cause ICU mortality was 27.8%. Compared to survivors, ICU non-survivors had a higher RRI [0.80 (0.10) versus 0.70 (0.10), p<0.001] and higher P(cv-a)CO2 / C(a-cv)O2 ratio [3.67 (3.8) versus 0.91 (1.4)] and lactate levels [2.80 (2.00) versus 1.50 (1.20)], both p <0.001). Logistic regression models showed a significant association between RRI and P(cv-a)CO2/C(a-cv)O2 ratio with clinical outcome. RRI showed good ability to predict ICU mortality (AUC 74.9% (95% CI 61% - 88.8%). The combination of RRI with P(cv-a)CO2)/(C(a-cv)O2 ratio and lactate better predicted mortality than RRI alone [AUC 84.8% (95% CI 5.1% - 94.4%)] versus 0.74.9%, respectively, p<0.001).Conclusions: In mechanically ventilated patients, renal blood flow impairment, assessed by the RRI on ICU admission, correlates with global tissue hypoperfusion indices. In addition, RRI in combination with tissue perfusion estimation is more valuable in predicting clinical outcome than RRI alone.

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“…27 Plasma vitamin C concentration was positively associated with markers of antioxidants and was negatively associated with markers of oxidative stress in critically ill patients. 28 Additionally, vitamin C diminished inflammatory responses in patients with sepsis syndrome. 27 Depending on age and gender, the RDA for vitamin C is between 75 and 90 mg/day.…”

Section: Vitamin Cmentioning

confidence: 99%

The Potential Influence of Vitamin A, C, and D and Zinc Supplements on the Severity of COVID-19 Symptoms and Clinical Outcomes: An Updated Review of Literature

Alzaben

2020

Curr Res Nutr Food Sci

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Coronavirus disease-19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 is an ongoing viral epidemic that originated in China in December 2019. To date, no specific treatment is available for COVID-19. However, several studies have reported the benefits of vitamins A, C, and D and zinc in critically ill patients and in those with various infections, including respiratory infections and sepsis. The objective of this review is to discuss the potential role of vitamin A, C, and D and zinc supplementation in enhancing immune response, and reducing the severity of symptoms, and mortality rate in patients with COVID-19. Several clinical studies have shown that different doses of vitamins A, C, and D and/or zinc supplements reduce the ventilator, length of intensive care unit stay, and mortality rate. Future randomized clinical trials are warranted to conclusively establish protocols for the optimal doses of vitamin A, C, and D, as well as zinc supplements for improved clinical outcomes in patients with COVID-19.

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Renal Resistive Index: Response to Shock and its Determinants in Critically Ill Patients

Cited by 32 publications

References 33 publications

Renal Resistive Index on Intensive Care Unit Admission Correlates With Tissue Hypoperfusion Indices and Predicts Clinical Outcome

Renal Resistive Index on Intensive Care Unit Admission Correlates With Tissue Hypoperfusion Indices and Predicts Clinical Outcome

Renal Resistive Index on Intensive Care Unit Admission Correlates with Tissue Hypoperfusion Indices and Predicts Clinical Outcome

The Potential Influence of Vitamin A, C, and D and Zinc Supplements on the Severity of COVID-19 Symptoms and Clinical Outcomes: An Updated Review of Literature

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