Título

MONITORING PERIPHERAL PERFUSION IN SEPSIS ASSOCIATED ACUTE KIDNEY INJURY

Resumo

Introduction: Microcirculatory disorders have been consistently linked to the pathophysiology of sepsis. One of the major organs affected is the kidneys, resulting in sepsis-associated acute kidney injury (SA-AKI) that correlates considerably with mortality. The potential role of clinical assessment of peripheral perfusion as a possible tool for AKI management has not been established. Objective: This study sought to verify the prevalence of peripheral hypoperfusion in SA-AKI patients, its association with clinical outcomes over time, and with fluid balance. Study Design: Observational study. Methodology: Setting & Participants: Consecutive septic patients in the Intensive Care Unit between February 2019 and December 2019. Predictors: Capillary refill time (CRT) and peripheral perfusion index (PI). Outcomes: Prevalence of peripheral hypoperfusion and mortality rates. Analytical Approach: Prevalence and mortality analyses were compared using Fisher‘s exact test. Linear Model Mixed Effects test was used for the serial evolution of PI. Spearman test to correlation analyses. Logistic regression in multivariable analyses. Results: 141 patients were included, 28 (19%) in the non-SA-AKI group, and 113 (81%) in the SA-AKI group. The study revealed higher rates of peripheral hypoperfusion in the SA-AKI group using the CRT (OR 3.6; 95%CI 1.35-9.55; p < 0.05). However, this result lost significance after multivariate adjustment. Perfusion abnormalities in the SA-AKI group diagnosed by both CRT (RR 1.96; 95%CI 1.25-3.08) and PI (RR 1.98; 95%CI 1.37-2.86) methods were associated to higher rates of 28-day mortality (p < 0.01). The PI‘s temporal analysis showed a high predictive value for death over the first 72 h (p < 0.01). A weak negative correlation between post-resuscitation fluid PI values and the fluid balance was found within the first 24 hours of sepsis diagnosis (p < 0.05). Conclusions: Peripheral perfusion was not different intrinsically between patients with or without SA-AKI. Peripheral hypoperfusion measured with PI and CRT in the SA-AKI was a robust prognostic marker. This evaluation maintained its predictive value over the first 72 hours. The peripheral perfusion was negatively associated with fluid balance.

Área

Injúria Renal Aguda

Autores

ANA CAROLINA DE MIRANDA, ANA CAROLINA, Marcelo Mazza do Nascimento, Igor Alexandre Cortês Menezes