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      Influence of the mean airway pressure trajectory on the mortality and AKI occurrence in septic shock patients with mechanical ventilation: insights from the MIMIC-IV database

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          Abstract

          Background

          Mean airway pressure (Pmean) is a known prognostic marker for mortality and adverse outcomes in mechanically ventilated patients. However, most previous studies have relied on static measurements, leaving the impact of Pmean trajectory on clinical outcomes in septic shock patients unclear. This study aimed to investigate the effect of Pmean trajectory on survival rates and acute kidney injury (AKI) incidence in septic shock patients undergoing mechanical ventilation (MV).

          Methods

          A retrospective cohort study was implemented utilizing sepsis patient data from the MIMIC-IV database. Group-based trajectory modeling (GBTM) was applied to identify distinct Pmean trajectory groups among septic shock patients. Cox proportional hazards and logistic regression models were utilized to analyze associations between Pmean trajectory and both mortality and AKI incidence. A causal mediation analysis evaluated the intermediary effect of cumulative fluid balance over the first 72 h post-ICU admission.

          Results

          A total of 956 eligible patients were included. Based on model fitting criteria, five distinct Pmean trajectory groups were identified: group 1 (low-stable), group 2 (high-descend), group 3 (medium-ascend), group 4 (high-stable), and group 5 (higher-stable). Compared to the low-stable trajectory (group 1), trajectories in groups 3, 4, and 5 were associated with significantly higher 30-day mortality risks (HR = 1.40, 95% CI = 1.03–1.88; HR = 1.47, 95% CI = 1.01–2.13; HR = 2.54, 95% CI = 1.53–4.2, respectively), while group 2 exhibited similar mortality rates to group 1 (HR = 0.88, 95% CI = 0.60–1.30). Logistic regression analyses revealed that groups 3, 4, and 5 were also significant risk factors for AKI occurrence ( p < 0.05), with group 1 as the reference. Mediation analysis revealed that 20.5% (95% CI = 0.106–0.40) of the Pmean trajectory effect on AKI occurrence was mediated through cumulative fluid balance.

          Conclusion

          Pmean trajectories were strongly associated with mortality and AKI incidence in septic shock patients receiving MV.

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          Most cited references44

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

          Arif Khwaja, A. Khwaja (2012)
          Article 0 comments Cited 2608 times – based on 0 reviews     Review now
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            Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries.

            Giacomo Bellani, John Laffey, Tài Pham … (2016)
            Limited information exists about the epidemiology, recognition, management, and outcomes of patients with the acute respiratory distress syndrome (ARDS).
            Article 0 comments Cited 1602 times – based on 0 reviews     Review now
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              ACUTE KIDNEY INJURY IN PATIENTS HOSPITALIZED WITH COVID-19

              Jamie Hirsch, Jia H. Ng, Daniel Ross … (2020)
              The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis.
              Article 0 comments Cited 745 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yukang Dong: URI : https://loop.frontiersin.org/people/1686680/overviewRole: Role: Role: Role:
                Changyan Yang: Role:
                Run Sun: URI : https://loop.frontiersin.org/people/1989306/overviewRole: Role: Role: Role:
                Jiangquan Fu: URI : https://loop.frontiersin.org/people/2608431/overviewRole: Role: Role: Role:
                Rui Huang: URI : https://loop.frontiersin.org/people/2213265/overviewRole: Role: Role:
                Jia Yuan: Role: Role: Role: Role:
                Ying Wang: URI : https://loop.frontiersin.org/people/2979125/overviewRole: Role:
                Jinni Wang: Role: Role:
                Feng Shen: URI : https://loop.frontiersin.org/people/1345726/overviewRole: Role: Role: Role: Role:
                Journal
                Journal ID (nlm-ta): Front Med (Lausanne)
                Journal ID (iso-abbrev): Front Med (Lausanne)
                Journal ID (publisher-id): Front. Med.
                Title: Frontiers in Medicine
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2296-858X
                Publication date (Electronic): 05 March 2025
                Publication date Collection: 2025
                Volume: 12
                Electronic Location Identifier: 1552336
                Affiliations
                [1] 1Department of Intensive Care Unit, Guizhou Medical University Affiliated Hospital , Guiyang, China
                [2] 2Department of Emergency, Guizhou Provincial People’s Hospital , Guiyang, China
                [3] 3Department of Emergency Intensive Care Unit, Guizhou Medical University Affiliated Hospital , Guiyang, China
                Author notes

                Edited by: Guo-wei Tu, Fudan University, China

                Reviewed by: Yun Yan, Air Force Medical University, China

                Jing-Lun Liu, Chongqing Medical University, China

                *Correspondence: Feng Shen, doctorshenfeng@ 123456163.com

                †These authors have contributed equally to this work

                Article
                DOI: 10.3389/fmed.2025.1552336
                PMC ID: 11919853
                PubMed ID: 40109722
                SO-VID: d1b90221-f441-4ed0-a146-57c611f0f0e6
                Copyright © Copyright © 2025 Dong, Yang, Sun, Fu, Huang, Yuan, Wang, Wang and Shen.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 27 December 2024
                Date accepted : 20 February 2025
                Page count
                Figures: 6, Tables: 2, Equations: 0, References: 44, Pages: 13, Words: 7685
                Funding
                The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
                Categories
                Subject: Medicine
                Subject: Original Research
                Custom metadata
                section-at-acceptance Intensive Care Medicine and Anesthesiology

                Keywords: mean airway pressure,septic shock,acute kidney injury,mortality,mimic-iv database
                Data availability:
                Keywords: mean airway pressure, septic shock, acute kidney injury, mortality, mimic-iv database

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