Low Systemic XXXX Delivery and BP and Risk of Progression of Early AKI.

@entity1 @entity295 @entity101 @entity26 @entity880 @entity299
BACKGROUND AND OBJECTIVES: The optimal hemodynamic management of @entity1 with early AKI is unknown. This study aimed to investigate the association between hemodynamic parameters in early AKI and progression to severe AKI and hospital mortality. DESIGN, SETTING, @entity1 , _ MEASUREMENTS: This study retrospectively analyzed the data of all @entity1 admitted to the adult intensive care unit in a tertiary care center between July 2007 and June 2009 and identified those with stage 1 AKI (AKI I) per the AKI Network classification. In @entity1 in whom hemodynamic monitoring was performed within 12 hours of AKI I, hemodynamic parameters in the first 12 hours of AKI I and on the day of AKI III (if AKI III developed) or 72 hours after AKI I (if AKI III did not develop) were recorded. Risk factors for AKI III and mortality were identified using univariate and multivariate logistic regression analyses. RESULTS: Among 790 @entity1 with AKI I, 210 (median age 70 years; 138 @entity1 ) had hemodynamic monitoring within 12 hours of AKI I; 85 @entity1 (41.5%) progressed to AKI III and 91 (43%) died in the hospital. AKI progressors had a significantly higher Sequential Organ Failure Assessment score (8.0 versus 9.6; P<0.001), lower indexed systemic @entity26 delivery (DO2I) (median 325 versus 405 ml/min per m(2); P<0.001), higher central venous pressure (16 versus 13; P=0.02), and lower mean arterial blood pressure (MAP) (median 71 versus 74 mmHg; P=0.01) in the first 12 hours of AKI I compared with nonprogressors. Multivariate analysis confirmed that raised @entity880 , central venous pressure, and Sequential Organ Failure Assessment score as well as mechanical ventilation were independently associated with progression to AKI III; higher DO2I and MAP were independently associated with a lower risk of AKI III but not survival. The associations were independent of @entity295 , @entity299 , recent cardiac surgery, or chronic @entity101 . CONCLUSIONS: Higher DO2I and MAP in early AKI were independently associated with a lower risk of progression.
