Background: Given the traditional acceptance of higher central venous pressure (CVP) levels, clinicians ignore the incidence of acute kidney injury (AKI). The objective of this study is to assess whether elevated CVP is associated with increased AKI in critically ill patients with multiple comorbidities.
Methods: This was a retrospective observational cohort study using data collected from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-III) open-source clinical database (version 1.4). Critically ill adult patients with CVP and serum creatine measurement records were included. Linear and multivariable logistic regression were performed to determine the association between elevated CVP and AKI.
Results: A total of 11135 patients were enrolled in our study. Critically ill patients in higher quartiles of mean CVP presented greater KDIGO AKI severity stages in 2 and 7 days. Linear regression showed CVP quartile was positively correlated with the incidence of AKI within 2 (R2=0.989, P=0.005) and 7 days (R2=0.990, P=0.004). Furthermore, patients in the highest quartile of mean CVP had a higher risk of AKI in 7 days compared with those in the lowest quartile of mean CVP, with an OR of 2.21 (95% CI: 1.85-2.65) after adjusting for demographics, treatments and comorbidities. The adjusted odds of AKI were 1.07 (95% CI: 1.06-1.09) per 1 mmHg increase in mean CVP.
Conclusions: Elevated CVP is associated with an increased risk of AKI in critically ill patients with multiple comorbidities. The optimal CVP should be personalized and kept at a low level to avoid AKI in critical care settings.
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