# Re-exploring the association between the central venous pressure and the risk of sepsis-associated acute kidney injury according to the latest definition: Analysis of the MIMIC-IV database

## TL;DR

This study finds that high central venous pressure is linked to higher risk and mortality from sepsis-related kidney injury, suggesting optimal pressure ranges for better outcomes.

## Contribution

The study re-examines CVP's role in SA-AKI using the latest definition and identifies a U-shaped mortality risk pattern.

## Key findings

- Higher CVP levels are independently associated with increased SA-AKI risk.
- CVP ≥10.19mmHg and ≥13.67mmHg are linked to 33% and 48% higher SA-AKI incidence, respectively.
- A U-shaped relationship between CVP and mortality was observed, with lowest risk between 4.89 and 13.12 mmHg.

## Abstract

The lack of a standard definition for sepsis-associated acute kidney injury (SA-AKI) makes the association between central venous pressure (CVP) and SA-AKI risk unclear. This study analyzed the relationship between CVP levels and the incidence and mortality of SA-AKI based on the most recent definition of the disease.

This retrospective observational study utilized clinical records of sepsis patients from 2008 to 2019 admitted to the critical care unit (ICU) and in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included. Based on the Acute Disease Quality Initiative (ADQI) definition of SA-AKI, patients were stratified into SA-AKI and non-SA-AKI groups. Patients were further categorized into four groups based on the CVP levels by the optimal prediction of SA-AKI incidence retrospectively. Cox proportional hazards models and a restricted cubic splines (RCS) model were employed to evaluate the relationship between CVP levels and SA-AKI risk. Additionally, Kaplan-Meier survival analysis was conducted to compare disparities in primary and secondary endpoints across groups stratified by CVP levels.

A total of 6129 patients were included. An independent relationship was observed between CVP levels and the risk of SA-AKI (p <0.001). Cox proportional hazards analysis demonstrated that SA-AKI incidence increased by 33% in patients with CVP≥10.19mmHg and 48% in patients with CVP≥13.67mmHg compared to patients with CVP<6.87mmHg. RCS analysis demonstrated a U-shaped association between CVP levels and mortality. In addition, the 90-day mortality risk decreased when CVP was between 4.89 and 13.12 mmHg (p< 0.001).

Elevated CVP levels are associated with the occurrence of SA-AKI in sepsis patients. Maintaining CVP levels between 4.89mmHg and 10.19mmHg may help reduce the incidence and mortality of SA-AKI.