Elevated Central Venous Pressure is Associated with Increased Mortality and Acute Kidney Injury in Critically Ill Patients: a Meta-analysis

Overview

Journal Crit Care

Specialty Critical Care

Date 2020 Mar 7

PMID 32138764

Citations 36

Authors

Chuan-Yu Chen

Yan Zhou

Peng Wang

En-Yao Qi

Wan-Jie Gu

Affiliations

Soon will be listed here.

Abstract

Background: The association of central venous pressure (CVP) and mortality and acute kidney injury (AKI) in critically ill adult patients remains unclear. We performed a meta-analysis to determine whether elevated CVP is associated with increased mortality and AKI in critically ill adult patients.

Methods: We searched PubMed and Embase through June 2019 to identify studies that investigated the association between CVP and mortality and/or AKI in critically ill adult patients admitted into the intensive care unit. We calculated the summary odds ratio (OR) and 95% CI using a random-effects model.

Results: Fifteen cohort studies with a broad spectrum of critically ill patients (mainly sepsis) were included. On a dichotomous scale, elevated CVP was associated with an increased risk of mortality (3 studies; 969 participants; OR, 1.65; 95% CI, 1.19-2.29) and AKI (2 studies; 689 participants; OR, 2.09; 95% CI, 1.39-3.14). On a continuous scale, higher CVP was associated with greater risk of mortality (5 studies; 7837 participants; OR, 1.10; 95% CI, 1.03-1.17) and AKI (6 studies; 5446 participants; OR, 1.14; 95% CI, 1.06-1.23). Furthermore, per 1 mmHg increase in CVP increased the odds of AKI by 6% (4 studies; 5150 participants; OR, 1.06; 95% CI, 1.01-1.12). Further analyses restricted to patients with sepsis showed consistent results.

Conclusions: Elevated CVP is associated with an increased risk of mortality and AKI in critically ill adult patients admitted into the intensive care unit.

Trial Registration: PROSPERO, CRD42019126381.

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References

Higgins J, Thompson S . Quantifying heterogeneity in a meta-analysis. Stat Med. 2002; 21(11):1539-58. DOI: 10.1002/sim.1186. View

Wong B, Chan M, Glassford N, Martensson J, Bion V, Chai S . Mean arterial pressure and mean perfusion pressure deficit in septic acute kidney injury. J Crit Care. 2015; 30(5):975-81. DOI: 10.1016/j.jcrc.2015.05.003. View

Yegenaga I, Hoste E, Van Biesen W, Vanholder R, Benoit D, Kantarci G . Clinical characteristics of patients developing ARF due to sepsis/systemic inflammatory response syndrome: results of a prospective study. Am J Kidney Dis. 2004; 43(5):817-24. DOI: 10.1053/j.ajkd.2003.12.045. View

Long Y, Su L, Zhang Q, Zhou X, Wang H, Cui N . Elevated Mean Airway Pressure and Central Venous Pressure in the First Day of Mechanical Ventilation Indicated Poor Outcome. Crit Care Med. 2017; 45(5):e485-e492. DOI: 10.1097/CCM.0000000000002290. View

Boyd J, Forbes J, Nakada T, Walley K, Russell J . Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2010; 39(2):259-65. DOI: 10.1097/CCM.0b013e3181feeb15. View

Brengelmann G . A critical analysis of the view that right atrial pressure determines venous return. J Appl Physiol (1985). 2002; 94(3):849-59. DOI: 10.1152/japplphysiol.00868.2002. View

Palomba H, de Castro I, Neto A, Lage S, Yu L . Acute kidney injury prediction following elective cardiac surgery: AKICS Score. Kidney Int. 2007; 72(5):624-31. DOI: 10.1038/sj.ki.5002419. View

Wang X, Chen H, Liu D, Zhang Q, Su L . The correlation between CVP-derived parameters and the prognosis of critically ill patients. J Crit Care. 2017; 40:257-264. DOI: 10.1016/j.jcrc.2017.03.011. View

Mullens W, Abrahams Z, Francis G, Sokos G, Taylor D, Starling R . Importance of venous congestion for worsening of renal function in advanced decompensated heart failure. J Am Coll Cardiol. 2009; 53(7):589-596. PMC: 2856960. DOI: 10.1016/j.jacc.2008.05.068. View

10.

Raimundo M, Crichton S, Syed Y, Martin J, Beale R, Treacher D . Low Systemic Oxygen Delivery and BP and Risk of Progression of Early AKI. Clin J Am Soc Nephrol. 2015; 10(8):1340-9. PMC: 4527018. DOI: 10.2215/CJN.02780314. View

11.

Ljungman S, LARAGH J, Cody R . Role of the kidney in congestive heart failure. Relationship of cardiac index to kidney function. Drugs. 1990; 39 Suppl 4:10-21; discussion 22-4. DOI: 10.2165/00003495-199000394-00004. View

12.

Chen X, Li S, Liu D, Yang R, Zhang H, Zhang H . [Effects of central venous pressure on acute kidney injury in septic shock]. Zhonghua Yi Xue Za Zhi. 2011; 91(19):1323-7. View

13.

Higgins J, Thompson S, Deeks J, Altman D . Measuring inconsistency in meta-analyses. BMJ. 2003; 327(7414):557-60. PMC: 192859. DOI: 10.1136/bmj.327.7414.557. View

14.

Pinsky M, Kellum J, Bellomo R . Central venous pressure is a stopping rule, not a target of fluid resuscitation. Crit Care Resusc. 2014; 16(4):245-6. View

15.

Magder S . Bench-to-bedside review: An approach to hemodynamic monitoring--Guyton at the bedside. Crit Care. 2012; 16(5):236. PMC: 3682240. DOI: 10.1186/cc11395. View

16.

van den Akker J, Bakker J, Groeneveld A, den Uil C . Risk indicators for acute kidney injury in cardiogenic shock. J Crit Care. 2018; 50:11-16. DOI: 10.1016/j.jcrc.2018.11.004. View

17.

Lobo S, Rezende E, Knibel M, Silva N, Paramo J, Nacul F . Early determinants of death due to multiple organ failure after noncardiac surgery in high-risk patients. Anesth Analg. 2010; 112(4):877-83. DOI: 10.1213/ANE.0b013e3181e2bf8e. View

18.

Chung K, Chang H, Huang Y, Liao C, Ho C, Jerng J . Central venous oxygen saturation under non-protocolized resuscitation is not related to survival in severe sepsis or septic shock. Shock. 2012; 38(6):584-91. DOI: 10.1097/SHK.0b013e318274c674. View

19.

Prowle J, Bellomo R . Fluid administration and the kidney. Curr Opin Crit Care. 2010; 16(4):332-6. DOI: 10.1097/MCC.0b013e32833be90b. View

20.

Beard D, Feigl E . Understanding Guyton's venous return curves. Am J Physiol Heart Circ Physiol. 2011; 301(3):H629-33. PMC: 3191500. DOI: 10.1152/ajpheart.00228.2011. View