• Journal of critical care · Feb 2025

    Decreased renal cortical perfusion post-EGDT is associated with MAKE-30 in sepsis.

    • Qiqi Li, Rong Li, Can Wang, Qian Zhang, Yan Huo, Yangong Chao, Xiaoting Wang, Zhenjie Hu, Lixia Liu, and Chinese Critical UltraSound Study Group(CCUSG).
    • Department of Critical Care Medicine, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
    • J Crit Care. 2025 Feb 1; 85: 154943154943.

    ObjectiveThis study explores alterations in renal cortical perfusion post-Early Goal-Directed Therapy (EGDT) in sepsis patients, to investigate its association with major adverse kidney events within 30 days (MAKE-30) and identify hemodynamic factors associated with renal cortical perfusion.MethodsSepsis patients admitted to the ICU from Jan 2022 to Jul 2023 were prospectively enrolled. Contrast-enhanced ultrasound (CEUS) assessed renal cortical perfusion post-EGDT. Hemodynamic parameters and renal resistive index (RRI) were collected. Patients were categorized into MAKE-30 and non-MAKE-30 groups. The study examined the association between renal cortical perfusion and MAKE-30, explored the hemodynamic factors related to renal cortical perfusion.ResultsOf 94 sepsis patients, 46 (48.9 %) experienced MAKE-30. Distinctions in pulmonary (P = 0.012) and abdominal infection sites (P = 0.001) and significant SOFA (P < 0.001) and APACHE II scores (P = 0.003) differences were observed. No significant differences in baseline characteristics, vasopressor, or diuretic doses were noted (P > 0.05). Hemodynamic parameters in MAKE-30 and non-MAKE-30 patients showed no significant differences. RRI was higher in MAKE-30 patients (0.71 vs 0.66 P = 0.005). Renal microcirculation parameters, including AUC (p = 0.035), rBV (p = 0.021), and PI (p = 0.003), were lower in MAKE-30. Reduced cortical renal perfusion was associated with an increased risk of MAKE-30. Renal cortical perfusion RT was identified as an independent factor associated with this risk (HR 2.278, 95 % CI (1.152-4.507), P = 0.018). RRI correlated with renal cortical perfusion AUC (r = -0.220 p 0.033).ConclusionDespite normal systemic hemodynamics post-sepsis EGDT, MAKE-30 patients show reduced renal cortical perfusion. CEUS-derived RT is an independent factor associated with this change. RRI correlates with renal cortical perfusion.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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