Influence of Time to Initial Central Venous Pressure Monitoring Post-ICU Admission on Acute Kidney Injury Incidence in Severe Septic Shock Patients: A Regression Analysis Utilizing MIMIC-IV Database
Authors: Chen Jiayi , Que Shuhao , Jin Guangyong , Ma Buqing , Wang Jianrong , Hu Wei , Qu Jianmin 
Published: March 2024

Abstract

OBJECTIVE
To investigate the impact of the timing of the initial central venous pressure (CVP) monitoring following admission to the Intensive Care Unit (ICU) on the occurrence of acute kidney injury in patients with septic shock.
METHODS
This study utilized the MIMIC database, focusing on the primary outcome variable: the incidence of acute kidney injury (AKI) within a 7-day period. The study population comprised patients with septic shock admitted to the Intensive Care Unit (ICU).The primary variable of interest in this study was the timing of the initial central venous pressure (CVP) measurement post-ICU admission. Secondary variables encompassed patient demographics (gender, age, ethnicity, etc.), vital signs (highest, lowest, and mean values within the initial 24 hours of ICU admission), laboratory test results (highest, lowest, and mean values within the initial 24 hours of ICU admission), comorbidities, and disease severity scores (OASISI, SOFA, APS-III, Charlson Comorbidity Index, SAPS II, etc.).The median was determined by fitting a curve with an odds ratio (OR) of 1 as the cut-off point. Subsequently, the study sample was categorized into two groups: the early-measurement central venous pressure (CVP) group (≤ 6 hours) and the delayed-measurement CVP group (> 6 hours).Logistic regression was employed following probability score matching (PSM) to compare outcomes between the two groups. RESULTS: The incidence of acute kidney injury (AKI) within 7 days was significantly lower in the early central venous pressure (CVP) measurement group (≤ 6 hours) (odds ratio [OR] = 0.53 [0.38–0.75], P < 0.001). Additionally, secondary variables, including calcium ion concentration, demonstrated statistical significance.
Result
In patients with septic shock admitted to the ICU, early monitoring of central venous pressure (CVP) (≤ 6 hours) significantly reduces the incidence of acute kidney injury (AKI) on the 7th day of ICU admission. Factors such as race, epinephrine, maximum heart rate, minimum hematocrit, minimum hemoglobin, and maximum calcium demonstrated notable associations with this outcome.There is a discernible correlation between race, epinephrine use, maximum heart rate, minimum hematocrit, minimum hemoglobin, maximum calcium concentration, minimum chloride concentration, and OASIS score, with the 7-day incidence rate of acute kidney injury (AKI). The odds ratios (ORs) for these indicators were 0.2 (0.09–0.41), 2.95 (1.53–5.66), 0.98 (0.98–0.99), 1.14 (1.04–1.25), 0.64 (0.49–0.85), 1.69 (1.35–2.11), 0.96 (0.94–0.99), and 1.13 (1.11–1.15), respectively.
Conclusion
For patients with septic shock admitted to the ICU, early monitoring of CVP (≤ 6 hours) significantly reduces the 7-day incidence of AKI in the ICU. It is advisable for these patients to undergo internal jugular vein catheterization promptly, with a preference for internal jugular vein over femoral vein catheterization if there are no contraindications. Race, epinephrine use, maximum heart rate, minimum hematocrit, minimum hemoglobin, maximum calcium concentration, minimum chloride concentration, and OASIS score may be considered independent risk factors.