Effect of timing of fluid resuscitation on changes in peripheral vascular resistance and prognosis of patients with acute kidney injury
Objective:To investigate the impact of fluid resuscitation at different time points on the therapeutic efficacy of patients with acute kidney injury(AKI)and the influence of changes in systemic vascular resistance(SVR)on prognosis.Methods:Clinical data from 116 patients with AKI caused by sepsis were collected.Patients were divided into an early resus-citation group(55 cases)and a delayed resuscitation group(61 cases)based on the timing of fluid resuscitation.Changes in serum creatinine(Scr),blood urea nitrogen(BUN),and hemodynamic parameters were compared between the two groups before and after resuscitation at different time points.The need for renal replacement therapy,length of hospital stay,dura-tion of mechanical ventilation,renal function recovery rate,and occurrence of complications were also compared between the two groups.The Kaplan-Meier method was used to draw survival curves and analyze 28-day survival in both groups.Receiver operating characteristic(ROC)curves were used to analyze the predictive value of SVR at 24 h after resuscitation for 28-day survival.Results:Compared with before resuscitation,Scr,BUN,and SVR were significantly reduced,and cardiac output(CO)and stroke volume(SV)were significantly increased at 24,48,and 72 h after resuscitation and at ICU discharge in both groups.The early resuscitation group had significantly lower Scr,BUN,and SVR levels and significantly higher CO and SV than the delayed resuscitation group(all P＜0.05).The early resuscitation group had significantly shorter ICU stay and duration of mechanical ventilation and a significantly higher renal function recovery rate than the delayed resuscitation group(all P＜0.05).There was no statistically significant difference in the overall incidence of complications between the two groups(7.27％vs.11.48％,P＞0.05).The 28-day mortality rate was significantly lower in the early resuscitation group than the delayed resuscitation group(30.91％vs.52.46％,P＜0.05).The area under the ROC curve for predicting 28-day mortality based on SVR at 24 h after resuscitation was 0.863(95％CI:0.817-0.924,P＜0.001).Conclusion:Early fluid resuscitation can rapidly improve renal function and SVR in patients with AKI and reduce mortality.
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