Cargando…

The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials

BACKGROUND: We aimed to study the incidence of acute kidney injury (AKI) in out-of-hospital cardiac arrest (OHCA) patients treated according to low-normal or high-normal mean arterial pressure (MAP) targets. METHODS: A post hoc analysis of the COMACARE (NCT02698917) and Neuroprotect (NCT02541591) tr...

Descripción completa

Detalles Bibliográficos
Autores principales: Laurikkala, Johanna, Ameloot, Koen, Reinikainen, Matti, Palmers, Pieter-Jan, De Deyne, Cathy, Bert, Ferdinande, Dupont, Matthias, Janssens, Stefan, Dens, Joseph, Hästbacka, Johanna, Jakkula, Pekka, Loisa, Pekka, Birkelund, Thomas, Wilkman, Erika, Vaara, Suvi T., Skrifvars, Markus B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663425/
https://www.ncbi.nlm.nih.gov/pubmed/37987871
http://dx.doi.org/10.1186/s13613-023-01210-0
_version_ 1785148634756546560
author Laurikkala, Johanna
Ameloot, Koen
Reinikainen, Matti
Palmers, Pieter-Jan
De Deyne, Cathy
Bert, Ferdinande
Dupont, Matthias
Janssens, Stefan
Dens, Joseph
Hästbacka, Johanna
Jakkula, Pekka
Loisa, Pekka
Birkelund, Thomas
Wilkman, Erika
Vaara, Suvi T.
Skrifvars, Markus B.
author_facet Laurikkala, Johanna
Ameloot, Koen
Reinikainen, Matti
Palmers, Pieter-Jan
De Deyne, Cathy
Bert, Ferdinande
Dupont, Matthias
Janssens, Stefan
Dens, Joseph
Hästbacka, Johanna
Jakkula, Pekka
Loisa, Pekka
Birkelund, Thomas
Wilkman, Erika
Vaara, Suvi T.
Skrifvars, Markus B.
author_sort Laurikkala, Johanna
collection PubMed
description BACKGROUND: We aimed to study the incidence of acute kidney injury (AKI) in out-of-hospital cardiac arrest (OHCA) patients treated according to low-normal or high-normal mean arterial pressure (MAP) targets. METHODS: A post hoc analysis of the COMACARE (NCT02698917) and Neuroprotect (NCT02541591) trials that randomized patients to lower or higher targets for the first 36 h of intensive care. Kidney function was defined using the Kidney Disease Improving Global Outcome (KDIGO) classification. We used Cox regression analysis to identify factors associated with AKI after OHCA. RESULTS: A total of 227 patients were included: 115 in the high-normal MAP group and 112 in the low-normal MAP group. Eighty-six (38%) patients developed AKI during the first five days; 40 in the high-normal MAP group and 46 in the low-normal MAP group (p = 0.51). The median creatinine and daily urine output were 85 μmol/l and 1730 mL/day in the high-normal MAP group and 87 μmol/l and 1560 mL/day in the low-normal MAP group. In a Cox regression model, independent AKI predictors were no bystander cardiopulmonary resuscitation (p < 0.01), non-shockable rhythm (p < 0.01), chronic hypertension (p = 0.03), and time to the return of spontaneous circulation (p < 0.01), whereas MAP target was not an independent predictor (p = 0.29). CONCLUSION: Any AKI occurred in four out of ten OHCA patients. We found no difference in the incidence of AKI between the patients treated with lower and those treated with higher MAP after CA. Higher age, non-shockable initial rhythm, and longer time to ROSC were associated with shorter time to AKI. Clinical trial registration: COMACARE (NCT02698917), NEUROPROTECT (NCT02541591). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-023-01210-0.
format Online
Article
Text
id pubmed-10663425
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-106634252023-11-21 The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials Laurikkala, Johanna Ameloot, Koen Reinikainen, Matti Palmers, Pieter-Jan De Deyne, Cathy Bert, Ferdinande Dupont, Matthias Janssens, Stefan Dens, Joseph Hästbacka, Johanna Jakkula, Pekka Loisa, Pekka Birkelund, Thomas Wilkman, Erika Vaara, Suvi T. Skrifvars, Markus B. Ann Intensive Care Research BACKGROUND: We aimed to study the incidence of acute kidney injury (AKI) in out-of-hospital cardiac arrest (OHCA) patients treated according to low-normal or high-normal mean arterial pressure (MAP) targets. METHODS: A post hoc analysis of the COMACARE (NCT02698917) and Neuroprotect (NCT02541591) trials that randomized patients to lower or higher targets for the first 36 h of intensive care. Kidney function was defined using the Kidney Disease Improving Global Outcome (KDIGO) classification. We used Cox regression analysis to identify factors associated with AKI after OHCA. RESULTS: A total of 227 patients were included: 115 in the high-normal MAP group and 112 in the low-normal MAP group. Eighty-six (38%) patients developed AKI during the first five days; 40 in the high-normal MAP group and 46 in the low-normal MAP group (p = 0.51). The median creatinine and daily urine output were 85 μmol/l and 1730 mL/day in the high-normal MAP group and 87 μmol/l and 1560 mL/day in the low-normal MAP group. In a Cox regression model, independent AKI predictors were no bystander cardiopulmonary resuscitation (p < 0.01), non-shockable rhythm (p < 0.01), chronic hypertension (p = 0.03), and time to the return of spontaneous circulation (p < 0.01), whereas MAP target was not an independent predictor (p = 0.29). CONCLUSION: Any AKI occurred in four out of ten OHCA patients. We found no difference in the incidence of AKI between the patients treated with lower and those treated with higher MAP after CA. Higher age, non-shockable initial rhythm, and longer time to ROSC were associated with shorter time to AKI. Clinical trial registration: COMACARE (NCT02698917), NEUROPROTECT (NCT02541591). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-023-01210-0. Springer International Publishing 2023-11-21 /pmc/articles/PMC10663425/ /pubmed/37987871 http://dx.doi.org/10.1186/s13613-023-01210-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Laurikkala, Johanna
Ameloot, Koen
Reinikainen, Matti
Palmers, Pieter-Jan
De Deyne, Cathy
Bert, Ferdinande
Dupont, Matthias
Janssens, Stefan
Dens, Joseph
Hästbacka, Johanna
Jakkula, Pekka
Loisa, Pekka
Birkelund, Thomas
Wilkman, Erika
Vaara, Suvi T.
Skrifvars, Markus B.
The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials
title The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials
title_full The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials
title_fullStr The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials
title_full_unstemmed The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials
title_short The effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the COMACARE and NEUROPROTECT trials
title_sort effect of higher or lower mean arterial pressure on kidney function after cardiac arrest: a post hoc analysis of the comacare and neuroprotect trials
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10663425/
https://www.ncbi.nlm.nih.gov/pubmed/37987871
http://dx.doi.org/10.1186/s13613-023-01210-0
work_keys_str_mv AT laurikkalajohanna theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT amelootkoen theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT reinikainenmatti theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT palmerspieterjan theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT dedeynecathy theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT bertferdinande theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT dupontmatthias theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT janssensstefan theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT densjoseph theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT hastbackajohanna theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT jakkulapekka theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT loisapekka theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT birkelundthomas theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT wilkmanerika theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT vaarasuvit theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT skrifvarsmarkusb theeffectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT laurikkalajohanna effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT amelootkoen effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT reinikainenmatti effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT palmerspieterjan effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT dedeynecathy effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT bertferdinande effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT dupontmatthias effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT janssensstefan effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT densjoseph effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT hastbackajohanna effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT jakkulapekka effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT loisapekka effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT birkelundthomas effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT wilkmanerika effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT vaarasuvit effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials
AT skrifvarsmarkusb effectofhigherorlowermeanarterialpressureonkidneyfunctionaftercardiacarrestaposthocanalysisofthecomacareandneuroprotecttrials