Venous Return Pressure Gradient as a Predictor of Acute Kidney Injury (VRPG-AKI)
Venous Return Pressure Gradient Predicts Acute Kidney Injury Onset and Progression
Acute kidney injury (AKI) is a common and serious complication in the ICU. Current diagnostic indicators (such as creatinine and urine output) exhibit significant lag, and specific hemodynamic predictive markers are lacking. The venous return pressure gradient (Pmsf-CVP), based on Guyton's theory, reflects the driving pressure for venous return; however, its value in the early warning of AKI remains unclear. This study aims to investigate the predictive value of the venous return pressure gradient for the onset and progression of AKI in ICU patients, and to clarify its effectiveness as an AKI risk warning indicator.
Patients admitted to the ICU within 48 hours with risk factors for AKI (including sepsis, shock, major surgery, underlying diseases, etc.) who have radial artery catheterization and can undergo hemodynamic monitoring will be enrolled. Those undergoing maintenance dialysis/CRRT, ECMO support, or with missing core data precluding calculation of Pmsf-CVP or AKI assessment will be excluded.
The venous return pressure gradient (Pmsf-CVP, mmHg) will be measured within 48 hours of ICU admission using the transient stop-flow arm arterial-venous equilibrium pressure method. The primary outcome is to evaluate the association between the venous return pressure gradient level and AKI occurrence. Secondary outcomes include correlation analyses between the venous return pressure gradient level and serum creatinine and urine output within 48 hours of ICU admission, among others.
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Status
Warunki
Warunki
Interwencja / Leczenie
Interwencja / Leczenie
Typ studiów
Typ studiów
Zapisy (Szacowany)
Zapisy
Kontakty i lokalizacje
Kontakt w sprawie studiów
Kontakt w sprawie studiów
- Nazwa: rongan Liu
- Numer telefonu: +8615928731511
- E-mail: 35279240@qq.com
Kopia zapasowa kontaktu do badania
- Nazwa: chunling Chen
- Numer telefonu: +8618349304972
- E-mail: cclblingk@163.com
Kryteria uczestnictwa
Kryteria kwalifikacji
Kryteria kwalifikacji
Wiek uprawniający do nauki
- Dorosły
- Starszy dorosły
Akceptuje zdrowych ochotników
Metoda próbkowania
Badana populacja
Opis
Inclusion Criteria:
- Age ≥18 years
- Admitted to the intensive care unit (ICU) within 48 hours
- Central venous catheter in place for continuous central venous pressure (CVP) monitoring
- Radial artery catheter in place for hemodynamic monitoring including mean systemic filling pressure (Pmsf)
- No acute kidney injury (AKI) at ICU admission according to KDIGO criteria
Exclusion Criteria:
- Maintenance hemodialysis or continuous renal replacement therapy (CRRT) prior to ICU admission
- Previous kidney transplantation
- Pregnancy
- Extracorporeal membrane oxygenation (ECMO) support at ICU admission
- Incomplete core hemodynamic data precluding calculation of venous return pressure gradient (Pmsf-CVP) or AKI assessment
Plan studiów
Jak projektuje się badanie?
Szczegóły projektu
Co mierzy badanie?
Podstawowe miary wyniku
Podstawowe miary wyniku
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
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Acute Kidney Injury occurrence
Ramy czasowe: Within 48 hours of ICU admission
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Occurrence of acute kidney injury diagnosed according to KDIGO criteria (serum creatinine increase ≥1.5 times baseline, or ≥26 μmol/L within 48 hours, or urine output <0.5 mL/kg/h for ≥6 hours) during the ICU stay.
The association between venous return pressure gradient (Pmsf-CVP, measured within the first 48 hours of ICU admission using the Pmsf-arm method) and AKI occurrence will be assessed by multivariable logistic regression analysis, adjusting for APACHE II score, baseline serum creatinine, lactate, mean arterial pressure, sepsis, and shock.
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Within 48 hours of ICU admission
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Miary wyników drugorzędnych
Miary wyników drugorzędnych
Miara wyniku |
Opis środka |
Ramy czasowe |
|---|---|---|
|
Persistent Acute Kidney Injury
Ramy czasowe: Within 48 hours after AKI occurrence during the ICU stay
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Persistent AKI defined as failure of renal function to return to baseline within 48 hours after AKI occurrence during the ICU stay.
The predictive value of venous return pressure gradient (Pmsf-CVP) for persistent AKI will be evaluated by ROC curve analysis.
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Within 48 hours after AKI occurrence during the ICU stay
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AKI severity grade
Ramy czasowe: At the time of maximum AKI stage during the ICU stay, up to 28 days
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Maximum AKI stage (KDIGO stage 1, 2, or 3) achieved during the ICU stay.
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At the time of maximum AKI stage during the ICU stay, up to 28 days
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In-hospital mortality
Ramy czasowe: From ICU admission to hospital discharge, up to 90 days
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All-cause mortality during the index hospitalization.
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From ICU admission to hospital discharge, up to 90 days
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Total length of hospital stay
Ramy czasowe: From hospital admission to discharge or death, up to 90 days
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Number of days from hospital admission to hospital discharge or in-hospital death, whichever comes first.
Patients still hospitalized at day 90 will be censored at 90 days.
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From hospital admission to discharge or death, up to 90 days
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Correlation between venous return pressure gradient and serum creatinine
Ramy czasowe: Within 48 hours of ICU admission
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Spearman rank correlation analysis between Pmsf-CVP (measured within 48 hours of ICU admission) and serum creatinine levels (baseline creatinine at ICU admission and peak creatinine during ICU stay).
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Within 48 hours of ICU admission
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Correlation between venous return pressure gradient and lactate
Ramy czasowe: Within 48 hours of ICU admission
|
Spearman rank correlation analysis between Pmsf-CVP (measured within 48 hours of ICU admission) and lactate levels obtained from the first arterial blood gas analysis within 48 hours of ICU admission.
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Within 48 hours of ICU admission
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Duration of mechanical ventilation
Ramy czasowe: From intubation to first successful extubation
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Number of days on invasive mechanical ventilation from the time of first intubation to the first successful extubation.
Reintubation within 48 hours will be counted as continuous ventilation.
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From intubation to first successful extubation
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Length of ICU stay
Ramy czasowe: From ICU admission to ICU discharge
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Number of days from ICU admission to ICU discharge.
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From ICU admission to ICU discharge
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Współpracownicy i badacze
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Publikacje i pomocne linki
Publikacje ogólne
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- IRB No. 321 (2026)
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