Does systemic vascular resistance correlate with sepsis-associated acute kidney injury?

Purpose: Given the lack of data on systemic vascular resistance (SVR) as a prognostic marker in sepsis-associated acute kidney injury (S-AKI), this study aimed to explore the association between SVR and S-AKI. Methods: Two echocardiographic examinations were performed in septic shock patients. Echocardiographic data were recorded at intensive care unit admission and 24 hours later according to American Society of Echocardiography guidelines by an experienced sonographer. Kidney Disease Improving Global Outcomes criteria were applied to define the stage of acute kidney injury (AKI). SVR was calculated using the formula: 80 × (mean arterial pressure)/cardiac output. Results: A total of 66 patients were included in this study. Thirty-one patients (47.0%) developed severe AKI, whereas 35 patients (53.0%) had no AKI or stage 1 AKI. After adjusting for disease severity, we demonstrated that SVR was an independent risk factor in the development of severe AKI defined by the Kidney Disease Improving Global Outcomes criteria (odds ratio: 0.74 [0.58, 0.88], P = 0.003). SVR was significantly improved by the administration of vasopressor and fluid resuscitation. According to the degree of improvement, SVR was also analyzed into two categories (improvement rate >25%, improvement rate ≤25%). A better prognosis was seen in S-AKI patients whose SVR improvement rate was >25% (0.57 vs. 0.18, P = 0.031). Conclusions: In septic shock patients, there was no statistical difference in cardiac output. SVR was an independent risk factor of AKI development. Importantly, patients who demonstrated favorable changes in SVR parameters exhibited enhanced tissue perfusion. Moreover, early improvement in SVR was associated with better prognosis in S-AKI patients.