Association between peripheral perfusion index and postoperative acute kidney injury in major noncardiac surgery patients receiving continuous vasopressors: a post hoc exploratory analysis of the VEGA-1 trial.

acute kidney injury haemodynamics intraoperative hypotension perioperative outcomes peripheral perfusion index

Journal

British journal of anaesthesia
ISSN: 1471-6771
Titre abrégé: Br J Anaesth
Pays: England
ID NLM: 0372541

Informations de publication

Date de publication:
18 Jan 2024
Historique:
received: 16 05 2023
revised: 26 10 2023
accepted: 24 11 2023
medline: 20 1 2024
pubmed: 20 1 2024
entrez: 19 1 2024
Statut: aheadofprint

Résumé

The peripheral perfusion index is the ratio of pulsatile to nonpulsatile static blood flow obtained by photoplethysmography and reflects peripheral tissue perfusion. We investigated the association between intraoperative perfusion index and postoperative acute kidney injury in patients undergoing major noncardiac surgery and receiving continuous vasopressor infusions. In this exploratory post hoc analysis of a pragmatic, cluster-randomised, multicentre trial, we obtained areas and cumulative times under various thresholds of perfusion index and investigated their association with acute kidney injury in multivariable logistic regression analyses. In secondary analyses, we investigated the association of time-weighted average perfusion index with acute kidney injury. The 30-day mortality was a secondary outcome. Of 2534 cases included, 8.9% developed postoperative acute kidney injury. Areas and cumulative times under a perfusion index of 3% and 2% were associated with an increased risk of acute kidney injury; the strongest association was observed for area under a perfusion index of 1% (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 1.00-1.74, P=0.050, per 100%∗min increase). Additionally, time-weighted average perfusion index was associated with acute kidney injury (aOR 0.82, 95% CI 0.74-0.91, P<0.001) and 30-day mortality (aOR 0.68, 95% CI 0.49-0.95, P=0.024). Larger areas and longer cumulative times under thresholds of perfusion index and lower time-weighted average perfusion index were associated with postoperative acute kidney injury in patients undergoing major noncardiac surgery and receiving continuous vasopressor infusions. NCT04789330.

Sections du résumé

BACKGROUND BACKGROUND
The peripheral perfusion index is the ratio of pulsatile to nonpulsatile static blood flow obtained by photoplethysmography and reflects peripheral tissue perfusion. We investigated the association between intraoperative perfusion index and postoperative acute kidney injury in patients undergoing major noncardiac surgery and receiving continuous vasopressor infusions.
METHODS METHODS
In this exploratory post hoc analysis of a pragmatic, cluster-randomised, multicentre trial, we obtained areas and cumulative times under various thresholds of perfusion index and investigated their association with acute kidney injury in multivariable logistic regression analyses. In secondary analyses, we investigated the association of time-weighted average perfusion index with acute kidney injury. The 30-day mortality was a secondary outcome.
RESULTS RESULTS
Of 2534 cases included, 8.9% developed postoperative acute kidney injury. Areas and cumulative times under a perfusion index of 3% and 2% were associated with an increased risk of acute kidney injury; the strongest association was observed for area under a perfusion index of 1% (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 1.00-1.74, P=0.050, per 100%∗min increase). Additionally, time-weighted average perfusion index was associated with acute kidney injury (aOR 0.82, 95% CI 0.74-0.91, P<0.001) and 30-day mortality (aOR 0.68, 95% CI 0.49-0.95, P=0.024).
CONCLUSIONS CONCLUSIONS
Larger areas and longer cumulative times under thresholds of perfusion index and lower time-weighted average perfusion index were associated with postoperative acute kidney injury in patients undergoing major noncardiac surgery and receiving continuous vasopressor infusions.
CLINICAL TRIAL REGISTRATION BACKGROUND
NCT04789330.

Identifiants

DOI: 10.1016/j.bja.2023.11.054 PMID: 38242802
pubmed: 38242802
pii: S0007-0912(23)00734-1
doi: 10.1016/j.bja.2023.11.054
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT04789330']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

Auteurs

Sina Krone (S)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA; Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.

Michael P Bokoch (MP)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA.

Rishi Kothari (R)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA.

Nicholas Fong (N)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA.

Roberta T Tallarico (RT)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA.

Jillene Sturgess-DaPrato (J)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA.

Romain Pirracchio (R)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA.

Alexander Zarbock (A)

Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.

Matthieu Legrand (M)

Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA; INI-CRCT Network, Nancy, France. Electronic address: Matthieu.Legrand@ucsf.edu.

Classifications MeSH