Email Alert RSS
Volume 13 Issue 6
Nov.  2022
Turn off MathJax
Article Contents
Abstract
References
ZHANG Hongmin, CHEN Xiukai, WANG Xiaoting, LIU Dawei, CHAI Wenzhao. Peak Value of Central Venous Pressure and Acute Kidney Injury in Cardiac Patients After Cardiopulmonary Bypass Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(6): 1005-1011. DOI: 10.12290/xhyxzz.2022-0448
Citation: ZHANG Hongmin, CHEN Xiukai, WANG Xiaoting, LIU Dawei, CHAI Wenzhao. Peak Value of Central Venous Pressure and Acute Kidney Injury in Cardiac Patients After Cardiopulmonary Bypass Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(6): 1005-1011. DOI: 10.12290/xhyxzz.2022-0448
shu

Peak Value of Central Venous Pressure and Acute Kidney Injury in Cardiac Patients After Cardiopulmonary Bypass Surgery

  • 1.

    Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Pittsburgh Heart, Lung, Blood and Vascular Institute, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania 15261, USA

Funds: 

CAMS Innovation Fund for Medical Sciences 2020-I2M-C & T-B-045

More Information
  • Corresponding author:

    CHAI Wenzhao, E-mail: chaiwenzhao@126.com

  • Received Date: August 14, 2022
  • Accepted Date: October 09, 2022
  • Issue Publish Date: November 29, 2022
    Graphical Abstract
    • Abstract
  •   Objective  To explore the relationship between the post-operative peak value of central venous pressure (CVPp) and the incidence of acute kidney injury (AKI) in patients who had undergone cardiopulmonary bypass surgery (CBS).
      Methods  Clinical data were retrospectively collected from 1 May 2016 to 1 May 2018 from all patients undergoing CBS in the Department of Intensive Care Medicine, Peking Union Medical College Hospital. The CVP values immediately after transfer to ICU (CVP 0h) and at 6 h(CVP 6h), and CVPp within 48 h(CVPp 48h) of transfer to ICU, the incidence of AKI after 48 h of transfer to ICU and in-hospital mortality were recorded. The receiver operating characteristic (ROC) curve was used to evaluate the clinical value of CVP-related indicators in predicting AKI after CBS and determine the optimal threshold. The risk factors for AKI and in-hospital mortality after CBS were analysed using single factor and multifactorial Logistic regression.
      Results  A total of 485 patients after CBS who met the inclusion and exclusion criteria were enrolled, with an incidence of AKI after 48 h of transfer to ICU of 25.2% (122/485) and an in-hospital mortality rate of 2.5% (12/485). The ROC curve analysis showed that the area under the curve (AUC) for CVPp 48h to predict AKI after CBS was 0.634 (95% CI: 0.577-0.692, P < 0.001), with an optimal threshold value of 14 mm Hg, sensitivity of 49.6% and specificity of 63.5%. Multifactorial logistic regression analysis showed that hypertension(OR=2.505, 95% CI: 1.581-3.969, P < 0.001), pulmonary hyperten-sion(OR=2.552, 95% CI: 1.573-4.412, P < 0.001), prolonged aortic block time(OR=1.009, 95% CI: 1.004-1.014, P=0.001), and CVPp 48h≥14 mm Hg(OR=1.613, 95% CI: 1.030-2.526, P=0.037) were independent risk factors for AKI after CBS; CVPp 48h≥14 mm Hg was an independent risk factor for in-hospital death(OR=8.044, 95% CI: 1.579-40.979, P=0.012).
      Conclusions  CVPp 48h is associated with AKI in patients who have undergone CBS. The monitoring and management of CVP might be a way to improve the prognosis of these patients.
    • FullText(HTML)
    • References (28)
  • [1]
    Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study[J]. JAMA, 2005, 29: 813-818.
    [2]
    Lassnigg A, Schmidlin D, Mouhieddine M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study[J]. J Am Soc Nephrol, 2004, 15: 1597-1605. DOI: 10.1097/01.ASN.0000130340.93930.DD
    [3]
    Loef BG, Epema AH, Smilde TD, et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival[J]. J Am Soc Nephrol, 2005, 16: 195-200. DOI: 10.1681/ASN.2003100875
    [4]
    Burns KE, Chu MW, Novick RJ, et al. Perioperative N-acetylcysteine to prevent renal dysfunction in high-risk patients undergoing cabg surgery: a randomized controlled trial[J]. JAMA, 2005, 294: 342-350. DOI: 10.1001/jama.294.3.342
    [5]
    Magder S. Understanding central venous pressure: not a preload index?[J]. Curr Opin Crit Care, 2015, 21: 369-375. DOI: 10.1097/MCC.0000000000000238
    [6]
    De Backer D, Vincent JL. Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions[J]. Crit Care, 2018, 22: 43. DOI: 10.1186/s13054-018-1959-3
    [7]
    Honore PM, Jacobs R, Hendrickx I, et al. Prevention and treatment of sepsis-induced acute kidney injury: an update[J]. Ann Intensive Care, 2015, 5: 51. DOI: 10.1186/s13613-015-0095-3
    [8]
    Chen X, Wang X, Honore PM, et al. Renal failure in critically ill patients, beware of applying (central venous) pressure on the kidney[J]. Ann Intensive Care, 2018, 8: 91. DOI: 10.1186/s13613-018-0439-x
    [9]
    Spiegel R, Teeter W, Sullivan S, et al. The use of venous Doppler to predict adverse kidney events in a general ICU cohort[J]. Crit Care, 2020, 24: 615. DOI: 10.1186/s13054-020-03330-6
    [10]
    Williams JB, Peterson ED, Wojdyla D, et al. Central venous pressure after coronary artery bypass surgery: does it predict postoperative mortality or renal failure?[J]. J Crit Care, 2014, 29: 1006-1010. DOI: 10.1016/j.jcrc.2014.05.027
    [11]
    Gambardella I, Gaudino M, Ronco C, et al. Congestive kidney failure in cardiac surgery: the relationship between central venous pressure and acute kidney injury[J]. Interact Cardiovasc Thorac Surg, 2016, 23: 800-805. DOI: 10.1093/icvts/ivw229
    [12]
    Yang Y, Ma J, Zhao L. High central venous pressure is associated with acute kidney injury and mortality in patients underwent cardiopulmonary bypass surgery[J]. J Crit Care, 2018, 48: 211-215. DOI: 10.1016/j.jcrc.2018.08.034
    [13]
    Wang XT, Chen H, Liu DW, et al. The correlation between CVP-derived parameters and the prognosis of critically ill patients[J]. J Crit Care, 2017, 40: 257-264. DOI: 10.1016/j.jcrc.2017.03.011
    [14]
    Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)[J]. Crit Care, 2013, 17: 204. DOI: 10.1186/cc11454
    [15]
    Prowle JR, Forni LG, Bell M, et al. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative[J]. Nat Rev Nephrol, 2021, 17: 605-618. DOI: 10.1038/s41581-021-00418-2
    [16]
    Palomba H, de Castro I, Neto AL, et al. Acute kidney injury prediction following elective cardiac surgery: AKICS Score[J]. Kidney Int, 2007, 72: 624-631. DOI: 10.1038/sj.ki.5002419
    [17]
    Choi SJ, Ha EJ, Jhang WK, et al. Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients[J]. BMC Pediatr, 2018, 18: 58. DOI: 10.1186/s12887-018-1059-1
    [18]
    Wang XT, Yao B, Liu DW, et al. Central Venous Pressure Dropped Early is Associated with Organ Function and Prognosis in Septic Shock Patients: A Retrospective Observa-tional Study[J]. Shock, 2015, 44: 426-430. DOI: 10.1097/SHK.0000000000000445
    [19]
    Guyton AC. Determination of cardiac output by equating venous return curves with cardiac response curves[J]. Physiol Rev, 1955, 3: 123-129.
    [20]
    Berlin DA, Bakker J. Starling curves and central venous pressure[J]. Crit Care, 2015, 19: 55. DOI: 10.1186/s13054-015-0776-1
    [21]
    Boyd JH, Forbes J, Nakada TA, et al. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality[J]. Crit Care Med, 2011, 39: 259-265. DOI: 10.1097/CCM.0b013e3181feeb15
    [22]
    Denault AY, Couture P, Beaulieu Y, et al. Right Ventricu-lar Depression After Cardiopulmonary Bypass for Valvular Surgery[J]. J Cardiothorac Vasc Anesth, 2015, 29: 836-844. DOI: 10.1053/j.jvca.2015.01.011
    [23]
    Vonk-Noordegraaf A, Haddad F, Chin KM, et al. Right heart adaptation to pulmonary arterial hypertension: physiology and pathobiology[J]. J Am Coll Cardiol, 2013, 62: D22-D33. DOI: 10.1016/j.jacc.2013.10.027
    [24]
    Hrymak C, Strumpher J, Jacobsohn E. Acute Right Ventricle Failure in the Intensive Care Unit: Assessment and Management[J]. Can J Cardiol, 2017, 33: 61-71. DOI: 10.1016/j.cjca.2016.10.030
    [25]
    Zhang H, Wang X, Chen X, et al. Tricuspid annular plane systolic excursion and central venous pressure in mechani-cally ventilated critically ill patients[J]. Cardiovasc Ultrasound, 2018, 16: 11. DOI: 10.1186/s12947-018-0130-2
    [26]
    Vellinga NA, Ince C, Boerma EC. Elevated central venous pressure is associated with impairment of microcirculatory blood flow in sepsis: a hypothesis generating post hoc analysis[J]. BMC Anesthesiol, 2013, 13: 17. DOI: 10.1186/1471-2253-13-17
    [27]
    Mullens W, Abrahams Z, Francis GS, et al. Importance of venous congestion for worsening of renal function in advanced decompensated heart failure[J]. J Am Coll Cardiol, 2009, 53: 589-596. DOI: 10.1016/j.jacc.2008.05.068
    [28]
    Royster RL. Myocardial dysfunction following cardiopulmonary bypass: recovery patterns, predictors of inotropic need, theoretical concepts of inotropic administration[J]. J Cardiothorac Vasc Anesth, 1993, 7: 19-25. DOI: 10.1016/1053-0770(93)90093-Z
    • Related Articles

  • Cited by

    Periodical cited type(1)

    1. 刘景峰，李甜，白国强，赵梦雅，段美丽. 不同中心静脉压水平在脓毒症相关性急性肾损伤中的作用. 医学研究杂志. 2024(09): 56-62 .

    Other cited types(0)

Catalog

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (2133) PDF downloads (69) Cited by(1)
    Related
    Links: National Health Commission of the People's Republic of China Chinese Academy of Medical Sciences(CAMS) AMLC Check CNKI Database CNKI Term Online Chinese General Practice
    Address：Room 302,Third Floor,Building 7, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China
    Tel：010-69154261/4262
    E - mail：medj@pumch.cn mjpumch@126.com
    Copyright of website：Editorial Office of Medical Journal of Peking Union Medical College Hospital

    Supported by: Beijing Renhe Information Technology Co., Ltd.  Baidu Analytics

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return
    x Close Forever Close