Sepsis-associated acute kidney injury (SA-AKI) is linked to poor outcomes. The relationship between early systolic blood pressure and longer-term clinical outcomes in non-critically ill patients with SA-AKI has been incompletely described. This study aimed to examine whether mean systolic blood pressure during the first 48 hours after admission is associated with one-year outcomes in this population.
The investigators performed a single-center retrospective cohort study including non-critically ill adult patients admitted between 2011 and 2020. From 2,920 screened records, 476 patients met inclusion criteria. SA-AKI was defined as an increase in Sequential Organ Failure Assessment (SOFA) score ≥2 with acute kidney injury occurring within 48 hours of admission. Reported cohort characteristics included a mean age of 68.4 ± 14.5 years and 55% male. AKI severity at presentation was distributed as stage I in 55%, stage II in 21%, and stage III in 24% of patients.
The exposure of interest was the mean systolic blood pressure (SBP) measured over the first 48 hours after admission. Measurements were taken seven times (baseline and then every 8 hours). Mean SBP was categorized into four prespecified groups: ≤100 mmHg, 101–120 mmHg, 121–140 mmHg, and >140 mmHg. The study examined associations between these SBP categories and subsequent clinical outcomes.
Patients were followed for one year from admission. The primary outcome was a composite endpoint comprising any of the following: a ≥25% decline in estimated glomerular filtration rate (eGFR), initiation of long-term dialysis, or one-year mortality. Secondary reported endpoints included one-year mortality and 30-day mortality. The authors reported results both as crude event frequencies by SBP category and as adjusted hazard ratios.
The composite primary outcome occurred most frequently in the ≤100 mmHg SBP group (80%) compared with the 101–120 mmHg (51%), 121–140 mmHg (50%), and >140 mmHg (46%) groups (p < 0.001). One-year mortality was substantially higher in the lowest SBP category: 73% in the ≤100 mmHg group versus 32% in the 121–140 mmHg group (p < 0.001). AKI stage distribution and baseline demographics were reported as noted above.
In multivariable analyses adjusting for relevant covariates (details of covariates were not provided in the abstract), mean SBP ≤100 mmHg within the first 48 hours was associated with a higher risk of the composite outcome (hazard ratio [HR] 1.84; 95% confidence interval [CI] 1.15–2.93; p = 0.010).
For mortality endpoints, adjusted hazards were increased in the lowest SBP group: one-year mortality HR 2.89 (95% CI 1.68–4.99) and 30-day mortality HR 2.79 (95% CI 1.12–6.96). These findings indicate that the association with the composite outcome was driven largely by higher one-year mortality among patients with early mean SBP ≤100 mmHg.
The authors concluded that, among non-critically ill patients with SA-AKI, an early mean systolic blood pressure ≤100 mmHg during the initial 48 hours after admission was associated with worse one-year clinical outcomes, primarily due to increased mortality. They propose that early SBP may function as a prognostic marker to identify high-risk patients who may require closer monitoring or targeted interventions.
The study reports that in a cohort of patients with sepsis-associated acute kidney injury who were not critically ill, having a mean systolic blood pressure of 100 mmHg or lower in the first 48 hours after hospital admission was linked to worse outcomes at one year—mainly driven by a higher risk of death. The authors suggest early systolic blood pressure could help clinicians identify patients at higher risk.
The abstract lists keywords including acute kidney disease, acute renal failure, acute tubular necrosis, blood pressure, hemodynamic, and sepsis. MeSH terms reported in the source include Acute Kidney Injury (etiology, mortality, physiopathology), Blood Pressure/physiology, Glomerular Filtration Rate, Organ Dysfunction Scores, Prognosis, Renal Dialysis/statistics & numerical data, and Retrospective Studies.
Note: The summary above is based on the information provided in the source abstract. Specific details on adjustment covariates, additional baseline characteristics, exact statistical model specifications, and limitations beyond what is presented in the abstract were not reported in the source.