Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Fotopoulou Georgia
Dissertation committee:
Ρούτση Χριστίνα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ζακυνθινός Σπυρίδων, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπρούντζος Ηλίας, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μπολέτης Ιωάννης, Καθηγητής, Ιατρική Σχολή,ΕΚΠΑ
Καλομενίδης Ιωάννης,Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βασιλειάδης Ιωάννης, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κροκίδης Μιλτιάδης, Αναπληρωτής Καθηγητής, Ιατρική ΣΧολή, ΕΚΠΑ
Original Title:
Ο ρόλος της υπερηχογραφικής μελέτης της νεφρικής λειτουργίας στην πρόγνωση της νεφρικής βλάβης στους βαρέως πάσχοντες ασθενείς
Translated title:
Value of Doppler-based renal resistive index (RRI) in predicting acute kidney injury of early onset in critically ill patients
Summary:
Purpose: To investigate the effectiveness of renal resistive index (RRI) in predicting acutekidney injury (AKI) development and the relationship between RRI and tissue hypoperfusionindices in mechanically ventilated intensive care unit (ICU) patients. The association of RRIand hypoperfusion indices with clinical outcome was a secondary aim.Methods: In consecutively admitted patients requiring mechanical ventilation, RRI wasmeasured within 24 hours after admission. The central venous-arterial carbon dioxide partialpressure difference to oxygen content difference (P(cv-a)CO2/C(a-cv)O2 ratio) and arterial lactatewere used as global tissue hypoperfusion indices.Results: A total of 126 mechanically ventilated patients [median age 61 (IQR 28) years, 74%males] were enrolled in the study. Fifty-four (42.9%) patients developed AKI. Crude ICUmortality was 27%. Median RRI value was 0.68 (0.1) in patients without AKI and 0.82 (0.07) inpatients with AKI, (p<0.001). Multivariate logistic regression revealed that RRI was anindependent factor for AKI prediction (for RRI>0.7, OR 17.7; 95%CI: 2.8-111.1, p=0.002). Thearea under the receiver-operating characteristic (AUC ROC) curve for AKI prediction by RRIwas 0.936.RRI was significantly correlated with both P(cv-a)CO2/C(a-cv)O2 ratio and arteriallactate, r=0.64, p<0.0001 in both cases. The combination of RRI with P(cv-a)CO2)/(C(a-cv)O2 ratiowas better associated with the clinical outcome than RRI alone (AUC ROC 0.83 vs 0.749,respectively).Conclusions: In critically ill mechanically ventilated patients, RRI at ICU admission effectivelyidentifies the subset of high-risk patients for AKI development and correlates with global tissuehypoperfusion indices. In addition, RRI in combination with tissue perfusion estimation is morevaluable in predicting clinical outcome than RRI alone.
Main subject category:
Health Sciences
Keywords:
Renal resistive index, Acute kidney injury, Critically ill, Doppler ultrasound, Shock
Number of references:
193
