The Relationship between Blood Pressure Response Index and Acute Kidney Injury in Patients with Septic Shock: A Retrospective Study Based on the MIMIC-IV Database

Jiahui Liu; Xinghua Chen; Jinglan Wu; Li Yao

doi:10.71321/61pvj246

Authors

Jiahui Liu Anhui Medical University; The Second People's Hospital of Hefei, Intensive Care Unit;
Xinghua Chen Anhui Medical University
Jinglan Wu Anhui Medical University; The Second People's Hospital of Hefei, Intensive Care Unit;
Li Yao Anhui Medical University; The Second People's Hospital of Hefei, Intensive Care Unit;

DOI:

https://doi.org/10.71321/61pvj246

Keywords:

septic shock, acute kidney injury, blood pressure response index, intensive care unit, MIMIC-IV database

Abstract

Background: The blood pressure response index (BPRI) is the ratio of mean arterial pressure (MAP) to the vasoactive-inotropic score (VIS). It accurately reflects the response to vasoactive drugs in patients with septic shock and assesses the patient's vascular status. However, the relationship between BPRI and the occurrence of acute kidney injury (AKI) in patients with septic shock has never been studied.
Methods: This study retrospectively analyzed patients diagnosed with sepsis and using vasoactive drugs in the MIMIC-IV database. The patients were divided into four groups according to the BPRI level. The primary outcome is whether AKI occurs after the diagnosis of sepsis. The association between BPRI and outcome was assessed by constructing logistic regression models and plotting restricted cubic spline (RCS) curves. The predictive value of the BPRI for outcome was evaluated by plotting receiver operating characteristic (ROC) curves and comparing areas under the curves (AUC).
Results: 5524 patients with septic shock were finally included. The median age of the patients was 68.8 years, and 84.3% developed AKI after the diagnosis of sepsis. In a fully adjusted model, BPRI and the development of AKI were significantly correlated (OR [95%CI], 0.988 [0.979, 0.996], P=0.006). The results of the RCS curves suggested an "L"-shaped association and the inflection point was located at the level of 3.98. On the left side of the inflection point, there was a decreasing trend in the risk of AKI in patients as BPRI levels increased (OR [95%CI], 0.82 [0.747, 0.9], P<0.001). On the right side of the inflection point, there was no statistically significant association (OR [95%CI], 0.995 [0.985, 1.01], P=0.212). In addition, the BPRI showed favorable predictive value for outcome (AUC [95% CI], 0.624 [0.601, 0.639]).
Conclusion: We identified a distinct non-linear association between BPRI and AKI risk in septic shock, characterized by a critical inflection point at 3.98. Below this threshold, the likelihood of AKI rises sharply as BPRI decreases. Integrating perfusion pressure and vasopressor load, the BPRI serves as a readily available metric to stratify renal risk and recognize vascular hyporesponsiveness.

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