Nonlinear Relationship between Early Postoperative Pulse Pressure Variation and Acute Kidney Injury Risk in Older Cardiac Surgical Patients.
U-shaped link: pulse pressure variation near 0.14 at 12h tied to lowest kidney injury risk
Nonlinear Relationship between Early Postoperative Pulse Pressure Variation and Acute Kidney Injury Risk in Older Cardiac Surgical Patients.
Acute kidney injury (acute kidney injury) frequently complicates the postoperative course of older patients in surgical intensive care units (intensive care units), contributing to increased mortality and prolonged hospital stays.
This study investigated the relationship between pulse pressure variation during the first 12 and 24 h after intensive care units admission and the development of acute kidney injury, with a focus on potential nonlinear associations and optimal pulse pressure variation thresholds.
This retrospective cohort analysis utilized data from the MIMIC-IV and MIMIC-III databases.
near this pulse pressure variation level, acute kidney injury risk dropped to its lowest point
Of the 5,445 patients included, 2,574 (47.3%) developed acute kidney injury after surgery.
In multivariable analyses incorporating restricted cubic spline terms, a U-shaped relationship was identified between pulse pressure variation 12 h and acute kidney injury (p for nonlinearity = 0.0224).
This association was independently validated in a separate cohort (n = 897), where a pulse pressure variation 12 h of 0.142 was associated with a 59.8% risk reduction.
In contrast, pulse pressure variation 12 h provided better predictive value than pulse pressure variation 24 h, which showed no significant association with acute kidney injury.
Early postoperative pulse pressure variation demonstrates a U-shaped correlation with acute kidney injury risk in older patients undergoing cardiothoracic surgery, with both low and high values associated with higher incidence.
A pulse pressure variation 12 h around 0.14 was consistently linked to the lowest risk in both primary and validation cohorts. These findings remained robust after adjusting for multiple confounders.
pulse pressure variation assessed at 24 h, however, showed limited predictive utility.