78 patients were assessed for eligibility
36 were excluded
21 had already achieved EGDT goals
when admitted to ICU
8 had other shock causes
4 severe CKD or on recovery from AKI
3 severe intra-abdominal hypertension
2 unreached EGDT goals in 12 hours and
died in 24 hours
12 refused PiCCO catheter
29 included in research
CI increased≥10%(n=16)
CI increased<10%(n=13)
Figure 1. Flowchart of patients included in the study. EGDT, early goal-directed therapy; CKD,
chronic kidney disease; PiCCO, Pulse indicator continuous cardiac output; CI, cardiac index.
Figure 2. The relationship between cardiac index percent change and creatinine clearance
after resuscitation. Correlations were assessed by using Spearman regression model. Figure 3 shows
a significant positive correlation between CI percent change and Ccr after resuscitation (ρ=0.548;
P=0.002).
Figure 3. The relationship between CI percent change(%) and probability of different renal
outcomes
A. Logistic regression model of relationship between cardiac index percent change (%)
and the probability of no poor renal outcome. Note the plateau for the incidence of good renal
prognosis when the lower limit of cardiac index percent change was 50%. B. ROC curve for CI
percent change (%) to predict no poor renal outcome. The cardiac index percent change (%) after
resuscitation had a moderate predictive value of non-poor renal outcome ( AUC
0.739, P=0.012).
Using a cutoff value of 10% would have a sensitivity of 75% and specificity of 89%.
Table 1.Patients’ characteristics
CI un-increased group
CI increased group
P
(n=13)
(n=16)
Age (years)
78(69-86)
75(65-83)
0.29
Males n (%)
7(54)
8(50)
1.00
Hypertension n (%)
9(69)
10(63)
1.00
Diabetes mellitus n (%)
5(38)
4(25)
0.69
Lungs n (%)
6(46)
10(63)
0.47
Abdomen n (%)
7(54)
4(25)
0.14
Soft tissue n (%)
0(0)
1(6)
1.00
Other n (%)
0(0)
1(6)
1.00
APACHE score II
24(24-30)
23(19-27)
0.13
SOFA score
11(10-12)
11(8-12)
0.19
Mechanical ventilation n (%)
10(77)
13(81)
0.70
Norepinephrine (ug/kg/rmin)
0.3(0.1-0.4)
0.2(0.2-0.4)
0.36
Hydroxyethyl starch n (%)
8(62)
7(44)
0.46
Colloid fluid n (%)
11(85)
13(81)
1.00
Hydroxyethyl starch amount (ml/kg)
11.7(7.1-18.6)
7.9(7.1-10.0)
0.20
Colloid fluid amount (ml/kg)
13.8(7.1-20.0)
8.2(5.0-10.6)
0.20
Crystalloid fluid amount (ml/kg)
26.8(15.7-34.7)
28.3(18.9-42.8)
0.51
Resuscitation fluid amount(ml/kg)
35.8(27.6-53.6)
36.1(25.8-52.4)
0.86
6.0(6.0 -7.0)
6.0(5.0-6.0)
0.27
8(62)
1(6)
0.003
AKI 2-3on admission n (%)
6(46)
4(25)
0.27
Persistent AKI n (%)
4(31)
1(6)
0.14
AKI 0-1on admission n (%)
7(54)
12(75)
0.27
New AKI n (%)
2(15)
0(0)
0.19
6(46)
3(19)
0.23
8(6-14)
8(7-19)
0.98
6(46)
5(31)
0.47
Source of infection
Fluid Therapy
EGDT period (hour)
Poor renal outcome n (%)
Use of renal-replacement therapy n (%)
Days in ICU (days)
28-day mortality n (%)
CI, cardiac index; APACHE, Acute physiology, age, chronic health evaluation; SOFA, sequential
organ failure assessment. The data in the table are expressed as median (interquartile range) or number
(%).
Table 2. Hemodynamic parameters before and after EGDT
HR
(beats/min)
MAP
(mmHg)
CVP
(mmHg)
CI
(L/min/m2)
SVI
(ml/m2)
SVRI
(dyn.s.m2.cm-5)
GEDI
(ml/m2)
GEF
(%)
CFI
(L/min)
ScvO2
(%)
Lac
(mmol/L)
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
BeforeEGDT
After EGDT
P value
CI un-increased group
(n=13)
CI increased group
(n=16)
P
113(90–134)
91(73–114)
0.002
65(58–73)
87(69–98)
0.002
10(5–12)
10(8–15)
0.045
3.2(2.7–4.3)
3.0(2.6–4.0)
0.022
34(28–37)
36(32–38)
0.11
1478(1231–2076)
1652(1273–2391)
0.06
793(670–936)
878(673–1056)
0.17
15(13–20)
16(13–20)
0.36
4.0(3.2–5.3)
3.8(2.9–4.5)
0.008
80(73–85)
80(75–83)
0.81
3.2(1.5–5.1)
1.7(1.2–2.8)
0.039
117(87–130)
95(78–107)
0.013
64(55–67)
86(76–93)
<0.001
6(4–11)
11(8–15)
0.004
2.6(2.2–3.2)
3.8(3.1–5.2)
<0.001
29(23–36)
43(40– 48)
<0.001
1722(1497–2373)
1545(1185–1881)
0.163
651(634–771)
767(697–886)
<0.001
17(16–22)
23(20–24)
0.013
4.2(3.7–4.9)
5.0(4.4–5.9)
0.003
79(76–81)
84(81–84)
0.005
2.4(1.3–3.3)
1.3(0.9–1.7)
0.03
0.69
0.76
0.60
0.96
0.56
0.89
0.06
0.028
0.14
0.003
0.34
0.43
0.035
0.50
0.19
0.012
0.96
0.003
0.66
0.026
0.44
0.25
MAP, mean arterial pressure; CVP, central venous pressure; HR, heart rate; CI, cardiac index;
SVI, stroke volume index; SVRI, systemic vascular resistance index; GEDI, global enddiastolic volume index; GEF, global ejection fraction;ScvO2, central venous oxygen saturation ;
Lac, arterial lactate acid. The data in the table are expressed as median(interquartile range) or
number(%).
Table 3. Renal function parameters before and after EGDT
CI un-increased group
CI increased group
P
(n=13)
(n=16)
BeforeEGDT
68(49-261)
83(56-133)
0.74
After EGDT
83(55-215)
76(63-127)
0.86
1.0
0.98
BeforeEGDT
8.4(4.9-14.4)
7.8(5.7-10.0)
0.61
After EGDT
8.5(4.5-14.8)
7.9(4.7-9.0)
0.65
0.27
0.27
BeforeEGDT
140(70-375)
74(28-148)
0.11
After EGDT
169(60-254)
125(60-179)
0.55
0.68
0.048
BeforeEGDT
4010 (2395-9143)
7894(3424-9910)
0.24
After EGDT
2766(2100-8817)
3642(2174-7375)
0.69
0.60
0.004
BeforeEGDT
85(40-128)
73(23-119)
0.35
After EGDT
67(43-128)
98(70-150)
0.11
0.31
0.013
BeforeEGDT
85(17-129)
59(45-101)
0.69
After EGDT
53(22-93)
82 (52-126)
0.08
0.034
0.12
BeforeEGDT
0.6(0.1-12.3)
0.7(0.3-1.5)
0.64
After EGDT
1.0(0.1-8.9)
1.0(0.5-1.8)
0.83
0.53
0.41
Serum
Cr(umol/L)
P value
Serum
Bun(mmol/L)
P value
Serum
NGAL(ng/ml)
P value
Urinary
Cr(umol/L)
P value
Urine
output(ml/h)
P value
Ccr (ml/min)
P value
FeNa(%)
P value
Cr, creatinine ;Bun, urea nitrogen ; NGAL, neutrophil gelatinase-associated lipocalin ;Ccr, creatinine
clearance; FeNa, fractional excretion of sodium. The data in the table are expressed as
median(interquartile range) or number(%).