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Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest

Grand, Johannes; Hassager, Christian; Winther-Jensen, Matilde; Rundgren, Malin LU ; Friberg, Hans LU ; Horn, Janneke; Wise, Matt P.; Nielsen, Niklas LU ; Kuiper, Michael and Wiberg, Sebastian, et al. (2019) In Journal of Critical Care 50. p.234-241
Abstract

Purpose: This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA). Materials and methods: Post-hoc analysis of 851 comatose OHCA-patients surviving >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m2) 48 h after OHCA was inversely associated with MAP-group (70 (47–102), 84 (56–113), 94 (61–124), p <.001, for the <70-group, 70–80-group and > 80-group respectively). After adjusting for potential confounders, in a mixed model... (More)

Purpose: This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA). Materials and methods: Post-hoc analysis of 851 comatose OHCA-patients surviving >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m2) 48 h after OHCA was inversely associated with MAP-group (70 (47–102), 84 (56–113), 94 (61–124), p <.001, for the <70-group, 70–80-group and > 80-group respectively). After adjusting for potential confounders, in a mixed model including eGFR after 1, 2 and 3 days this association remained significant (pgroup_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratioadjusted = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg increase; p =.002]). Conclusions: Low mean MAP during TTM was independently associated with decreased renal function and need of renal replacement therapy in a large cohort of comatose OHCA-patients. Increasing MAP above the recommended 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.

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publication status
published
subject
keywords
Acute Kidney Injury, Blood pressure, Cardiac arrest, Dialysis, Post-resuscitation syndrome
in
Journal of Critical Care
volume
50
pages
8 pages
publisher
Elsevier
external identifiers
  • scopus:85058785723
ISSN
0883-9441
DOI
10.1016/j.jcrc.2018.12.009
language
English
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yes
id
7dcd8b7c-1c4b-4f71-af92-4099f666f71a
date added to LUP
2019-01-02 11:11:13
date last changed
2019-02-20 11:41:05
@article{7dcd8b7c-1c4b-4f71-af92-4099f666f71a,
  abstract     = {<p>Purpose: This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA). Materials and methods: Post-hoc analysis of 851 comatose OHCA-patients surviving &gt;48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; &lt;70 mmHg (22%), 70–80 mmHg (43%), and &gt; 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m<sup>2</sup>) 48 h after OHCA was inversely associated with MAP-group (70 (47–102), 84 (56–113), 94 (61–124), p &lt;.001, for the &lt;70-group, 70–80-group and &gt; 80-group respectively). After adjusting for potential confounders, in a mixed model including eGFR after 1, 2 and 3 days this association remained significant (p<sub>group_adjusted</sub> = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio<sub>adjusted</sub> = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg increase; p =.002]). Conclusions: Low mean MAP during TTM was independently associated with decreased renal function and need of renal replacement therapy in a large cohort of comatose OHCA-patients. Increasing MAP above the recommended 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.</p>},
  author       = {Grand, Johannes and Hassager, Christian and Winther-Jensen, Matilde and Rundgren, Malin and Friberg, Hans and Horn, Janneke and Wise, Matt P. and Nielsen, Niklas and Kuiper, Michael and Wiberg, Sebastian and Thomsen, Jakob Hartvig and Jaeger Wanscher, Michael C. and Frydland, Martin and Kjaergaard, Jesper},
  issn         = {0883-9441},
  keyword      = {Acute Kidney Injury,Blood pressure,Cardiac arrest,Dialysis,Post-resuscitation syndrome},
  language     = {eng},
  month        = {04},
  pages        = {234--241},
  publisher    = {Elsevier},
  series       = {Journal of Critical Care},
  title        = {Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest},
  url          = {http://dx.doi.org/10.1016/j.jcrc.2018.12.009},
  volume       = {50},
  year         = {2019},
}