Association between ventilatory ratio and subsequent development of severe late acute kidney injury in acute respiratory distress syndrome.
Academic Article
Overview
abstract
OBJECTIVE: To investigate the association of a dead space ventilation index, namely ventilatory ratio (VR), with subsequent development of severe late acute kidney injury (AKI). DESIGN: Multicenter retrospective study. Secondary analysis of individual patient-level data from seven ARDS Network and PETAL Network randomized controlled trials. SETTING: Critically ill patients with ARDS. PATIENTS: We compared patients who developed severe AKI (stage II or III) more than two days but no longer than seven days following ARDS onset ("severe late AKI" group) with patients who did not develop severe late AKI ("no severe late AKI" group). INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: VR, severe late AKI. RESULTS: Of 3007 patients with ARDS included in the study, 376 (12.5%) developed severe late AKI. Baseline VR was independently associated with severe late AKI development [odds ratio (OR) 1.712, CI 1.096-2.674, p = 0.018)]. An adjusted linear mixed effects model revealed that trajectory of VR was higher in patients who developed severe late AKI than those who did not (estimate = 0.23, p < 0.001). Adjusted latent class mixed modeling identified two distinct trajectories of VR evolution over time, class 1 with lower trajectory over time, and class 2 with higher trajectory, which was independently associated with an increased risk of severe late AKI (OR 2.55, 95% CI 1.02-6.41, p = 0.046) compared to class 1. CONCLUSIONS: In ARDS, baseline value of VR was independently associated with severe late AKI, while its trajectory was significantly higher in patients who developed severe late AKI than those who did not.
