Association between blood pressure variability and acute kidney injury following transcatheter aortic valve replacement: a study based on the MIMIC-IV database

OBJECTIVES: Acute kidney injury (AKI) following transcatheter aortic valve replacement (TAVR) is a prevalent complication that impacts patient prognosis. While blood pressure variability (BPV) has been implicated in AKI among patients undergoing other surgical procedures, its association with AKI following TAVR remains uncharted. This study aimed to investigate the association between BPV and post-TAVR AKI. METHODS: Based on the Medical Information Mart for Intensive Care database, logistic regression models were employed to investigate the associations of average real variability of systolic blood pressure (ARV-SBP) and average real variability of diastolic blood pressure (ARV-DBP) with AKI following TAVR. Multiple sensitivity analyses evaluated the robustness of the results. The marginal standardization analysis estimated the odds of AKI after ARV-SBP adjustment. RESULTS: A total of 340 patients undergoing TAVR were enrolled, among whom 107 (31.5%) developed AKI. Logistic regression analysis demonstrated a positive correlation between ARV-SBP and the odds of post-TAVR AKI (OR = 1.34, 95%CI: 1.03-1.74, P=0.029) in the fully adjusted model. In contrast, no significant correlation was observed between ARV-DBP and AKI (P=0.559). In covariate and blood pressure measurement sensitivity analyses, the direction of the ARV-SBP effect was generally consistent with that in the primary analysis. Marginal standardization analysis demonstrated that higher ARV-SBP levels were associated with elevated odds of AKI. CONCLUSIONS: Elevated ARV-SBP was associated with increased odds of post-TAVR AKI. ARV-SBP may serve as an auxiliary indicator for early risk identification of post-TAVR AKI, yet its clinical value remains to be validated in prospective studies.