The value of combined hemodynamic, respiratory and intra-abdominal pressure monitoring in predicting acute kidney injury after major intraabdominal surgeries

Figures & data

Table 1. Demographics of patients at admission (median and IQR; case numbers and percentage).

	no-AKI (n = 45)	AKI (n = 39)	p
Male/female	30/15	19/20	NS
Age (years)	65.0 (60.0–76.5)	68.0 (59.0–79.0)	NS
SAPS II	33.0 (22.0–40.0)	49.5 (32.8–65.3)	<.01
SOFA	5.0 (2.0–10.0)	10.0 (5.8–11.8)	<.001
Non-renal SOFA	3.0 (1.0–7.0)	7.0 (4.0–9.0)	<.01
Albumin (g/L)	29.4 (24.0–35.5)	26.9 (22.1–32.1)	NS
Lactate (mmol/L)	1.5 (1.1–2.4)	2.4 (1.8–3.5)	<.01
BUN (mmol/L)
Preop	7.0 (4.5–9.0)	8.7 (5.1–14.8)	NS
Admission	5.1 (3.9–7.3)	10.0 (5.5–15.9)	<.01
Creatinine (micromol/L)
Preop	85 (70–104)	96 (73–137)	NS
Admission	73 (56–90)	127 (72–213)	<.001
Sepsis	3 (6.7%)	16 (41.0%)	<.001
Need of ventilation	15 (33.3%)	25 (64.1%)	<.05
ICU mortality	2 (4.4%)	9 (24%)	<.01
Hospital mortality	5 (11.1%)	13 (33.3%)	<.05
ICU length of stay (days)	2.0 (2.0–4.0)	5.0 (2.0–11.5)	<.001
Hospital length of stay (days)	11.0 (9.0–14.0)	13.0 (8.0–18.5)	NS

AKI: Acute Kidney Injury; BUN: Blood Urea Nitrogen; SAPS II: Simplified Acute Physiology Score version II; SOFA: Sepsis-related Organ Failure Assessment Score.

Table 2. The values of parameters (mmHg, median (IQR)).

Parameters		n	No AKI	n	AKI	p
MAP	Admission	45	89 (77–100)	39	82 (65–91)	NS
	6 h	45	75 (66–85)	39	72 (67–85)	NS
	12 h	45	76 (68–87)	39	72 (69–82)	NS
	24 h	42	81 (71–91)	37	80 (70–88)	NS
	48 h	32	81 (75–101)	37	82 (70–90)	NS
IAP	Admission	45	10 (6–13)	39	11 (7–16)	NS
	6 h	45	10 (6–12)	39	9 (7–14)	NS
	12 h	45	11 (7–13)	39	11 (7–15)	NS
	24 h	39	9 (7–13)	36	12 (8–16)	< .05
	48 h	29	10 (7–14)	37	12 (8–17)	NS
CVP	Admission	45	6 (2–10)	39	6 (4–8)	NS
	6 h	45	5 (1–8)	39	7 (4–8)	NS
	12 h	45	5 (2–7)	39	6 (4–9)	NS
	24 h	42	6 (4–7)	37	8 (3–11)	NS
	48 h	31	7 (4–9)	37	7 (5–11)	NS
Pmean	Admission	12	9 (7–10)	22	9 (8–11)	NS
	6 h	7	8 (7–10)	19	10 (6–11)	NS
	12 h	6	7 (7–10)	17	9 (7–12)	NS
	24 h	4	7 (6–9)	18	10 (7–12)	NS
	48 h	3	6 (6–7)	16	8 (7–14)	NS
MAP-IAP	Admission	45	88 (69–93)	39	65 (49–85)	< .005
	6 h	45	66 (56–74)	39	62 (55–77)	NS
	12 h	45	66 (57–77)	39	61 (53–76)	NS
	24 h	41	72 (60–84)	37	64 (57–77)	NS
	48 h	32	72 (63–91)	37	69 (57–82)	NS
MAP-(IAP + CVP + Pmean)	Admission	12	55 (50–59)	22	41 (30–52)	< .005
	6 h	7	49 (39–55)	19	44 (40–60)	NS
	12 h	6	57 (42–64)	17	40 (36–52)	< .05
	24 h	4	53 (45–58)	18	31 (18–46)	NS
	48 h	3	55 (52–59)	16	36 (3–50)	NS

AKI: Acute Kidney Injury; CVP: Central Venous Pressure; IAP: Intraabdominal Pressure; MAP: Mean Arterial Pressure.

Table 3. The change of RPP in the first 12 h after admission to ICU (mmHg, median (IQR)).

Parameter		n	No AKI	n	AKI	p
Δ[MAP-(IAP + CVP + Pmean)]	0–6 h	8	−5 (−41 to –6)	23	6 (−9 to –18)	NS
	6–12 h	7	9 (2–13)	21	−4 (−10 to –1)	<.05
	0–12 h	7	3 (−28 to –14)	21	−6 (−14 to –11)	NS

Figure 1. The patients' data with (A) below 40.7 mmHg of MAP−(IAP + CVP + Pmean) and above it (B) with or (C) without AKI in the first 12 h.

Figure 2. The course of MAP−(IAP + CVP + Pmean) in the first 12 h in ICU after major abdominal surgery. The p values within or between groups not shown were not statistically significant.

Figure 3. ROC analysis of the changes of RPP between 6 and 12 h after admission.

Data availability

The data that support the findings of this study are available from the corresponding author, CsK, upon reasonable request.