The Relationship of Mean Perfusion Pressure (MPP) with Acute Kidney Injury (AKI) on Patients in Intensive Care Unit (ICU) at Haji Adam Malik General Hospital Medan

Abstract

 Background: Acute Kidney Injury (AKI) is a common complication in patients with critical illness or multiple comorbid conditions who are hospitalized, especially at the Intensive Care Unit (ICU). AKI is associated with increased in short and long term mortality and morbidity. The connection between MAP and CVP on alteration of AKI causes researcher interested to investigate the correlation between Mean Perfusion Pressure (MPP) as a difference between MAP and CVP on the progression of AKI.  Methods: Forty-two patients treated in the ICU who met inclusion criteria (ages 18-65 years and signed informed consent) and exclusion criteria (chronic kidney disease, refused to have Central Venous Catheters (CVC) installed, and heart disease). After CVC installation, we perform hemodynamic examination, MAP and CVP measurements, and serum creatinine examination after installation, 6 hours, 12 hours, and 48 hours after installation.  Results: Significant differences were obtained during 12-hour observation between MPP values in the AKI group with lower values than the non-AKI group (p=0.009) and also obtained a significant difference during 48-hours observation between MPP values in the AKI group with a lower value than the non-AKI group (p=0.001). MAP values showed a significant difference at 12-hour observation time with creatinine serum in the MAP group<65mmHg higher than the MAP65mmHg group (p=0.035). MPP values showed significant differences 12-hours observation with creatinine serum in the MPP group<55mmHg was higher than the MPP group 55mmHg (p=0.044). In addition, there was a correlation between creatinine serum increase with MPP decrease (r=-0.476; p=0.001).  Conclusion: Lower MPP tend to increase AKI occurence contrary higher MPP decrease AKI occurence at the observation. The mean MPP of AKI group was 90.6 (24.2) mmHg at T0, 78.2 (22.6) mmHg at T1, 67.2 (20.9) mmHg at T3, and 57, 0 (20,2) mmHg at T4 observation.