ArticleCardiorenal medicine2026
Nonlinear Relationship between Early Postoperative Pulse Pressure Variation and Acute Kidney Injury Risk in Older Cardiac Surgical Patients.
Article in Cardiorenal medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAcute kidney injury (AKI) frequently complicates the postoperative course of older patients in surgical intensive care units (ICUs), contributing to increased mortality and prolonged hospital stays. Traditional AKI diagnostic methods, relying on changes in serum creatinine and urine output, often result in delayed detection. Pulse pressure variation (PPV), a dynamic hemodynamic parameter derived from arterial waveform analysis, reflects preload responsiveness and can provide early, complementary information on circulatory status and end-organ perfusion. Although both elevated and diminished PPV levels have been associated with adverse outcomes, the specific nature of the association between early postoperative PPV and AKI risk remains uncertain. This study investigated the relationship between PPV during the first 12 and 24 h after ICU admission and the development of AKI, with a focus on potential nonlinear associations and optimal PPV thresholds.
methodsThis retrospective cohort analysis utilized data from the MIMIC-IV and MIMIC-III databases. We included patients aged 60 years and older who underwent cardiothoracic surgery and had available PPV measurements within the first 24 h following ICU admission. The primary dataset was derived from MIMIC-IV, while MIMIC-III served as an external validation cohort. The main outcome was postoperative AKI, as identified by KDIGO criteria. Logistic regression models adjusted for relevant clinical covariates were used to assess associations between PPV at 12 and 24 h (PPV
resultsOf the 5,445 patients included, 2,574 (47.3%) developed AKI after surgery. Those with AKI were generally older and had more comorbidities and higher illness severity scores. In multivariable analyses incorporating RCS terms, a U-shaped relationship was identified between PPV
conclusionEarly postoperative PPV demonstrates a U-shaped correlation with AKI risk in older patients undergoing cardiothoracic surgery, with both low and high values associated with higher incidence. A PPV
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