The Duration of Hypotension Determines the Evolution of Bacteremia-Induced Acute Kidney Injury in the Intensive Care Unit

作者：van Doorn Karin Janssen^*; Verbrugghe Walter; Wouters Kristien; Jansens Hilde; Jorens Philippe G

来源：PLos One, 2014, 9(12): e114312.

DOI：10.1371/journal.pone.0114312

Background: Exploration of the impact of severe hypotension on the evolution of acute kidney injury in septic patients. %26lt;br%26gt;Methods and Results: We reviewed the hemodynamic parameters of 137 adults with septic shock and proven blood stream infection in the ICU. Severe hypotension was defined as a mean arterial blood pressure (MAP) %26lt;= 65 mmHg. The influence of the duration of severe hypotension on the evolution of acute kidney injury was evaluated according to the RIFLE classification, with day 0 defined as the day of a positive blood stream infection. After bloodstream infection, the probability for a patient to be in Failure was significantly higher than before blood stream infection (OR=1.94, p=0.0276). Patients have a significantly higher risk of evolving to Failure if the duration of severe hypotension is longer (OR=1.02 for each 10 minutes increase in duration of a MAP %26lt;65 mmHg, p=0.0472). A cut-off of at least 51 minutes of severe hypotension (%26lt;65 mmHg) or at least 5.5 periods of severe hypotension within 1 day identified patients with increased risk to evolve to Failure. %26lt;br%26gt;Conclusions: There is a significant influence of both the duration and the number of periods of severe hypotension on the evolution to Failure. Blood stream infection has a significantly negative effect on the relationship between severe hypotension and Failure.

• 出版日期2014-12-12