Microalbuminuria: An inexpensive,non invasive bedside tool to predict outcome in critically ill patients |
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Authors: | Surupa Basu S Chaudhuri M Bhattacharyya T K Chatterjee S Todi A Majumdar |
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Institution: | 1.Department of Laboratory Medicine,AMRI Hospitals,Kolkata,India;2.Department of Critical Care,AMRI Hospitals,Kolkata,India;3.Department of Nephrology,AMRI Hospitals,Kolkata,India;4.Department of Pharmaceutical Technology,Jadavpur University,Jadavpur, Kolkata,India |
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Abstract: | This study was conducted to evaluate whether microalbuminuria on admission and after 24 hrs of admission to intensive care
unit (ICU) predicts outcome as well as the Acute Physiology and Chronic Health Evaluation (APACHE) II severity illness score,
the current accepted method of doing so. The study was carried out in a 20 bed mixed medical-surgical ICU of a tertiary care
hospital. Of 525 consecutive adult patients with ICU stay of more than 24 hrs, 238 were included for the study. Patients with
pregnancy, menstruation, anuria, macroscopic hematuria, urinary tract infection, marked proteinuria due to renal and post-renal
structural diseases, were excluded. Spot urine samples were collected on admission to ICU and 24 hrs thereafter. Urine albumincreatinine
ratio (ACR) was measured on ICU admission (ACR1) and after 24 hrs (ACR2) and expressed in mg/g. Patient demographics were
noted on admission. For disease severity scoring, APACHE II scores were calculated. Each patient was followed up throughout
their ICU stay for a maximum of 28 days and the following outcome data were obtained: ICU length of stay and ICU mortality.
Of the 238 patients, 196 survived while 42 patients died in the ICU. Non-survivors had a significantly higher median ACR2
162.7 mg/g (IQR 69.5–344.3)] in comparison to the survivors who had a median ACR2 = 54.4 mg/g (IQR 19.0–129.1) (P< 0.0001).
The median ACR1 161.0 mg/g (IQR 29.0–369.3)] of non-survivors was higher than the median ACR1 80.4 mg/g (IQR 35.1–167.6)]
of survivors but failed to reach statistical significance (P= 0.0948). In a receiver operating characteristic curve (ROC)
analysis, ACR2 emerged as the best indicator of mortality (area under curve (AUC) of ACR2 = 0.71 > AUC (ACR1) =0.58 > AUC
(ΔACR) =0.55] similar to the currently used APACHE II scores (AUC = 0.78) (P=0.3). At a cutoff of 101 mg/g, ACR2 had a sensitivity
of 69%, specificity of 67%, positive predictive value of 31% and a negative predictive value of 91% for predicting mortality
in the critically ill patients. Absence of significant microalbuminuria at 24 hrs of ICU admission may help to predict survival
in the ICU. |
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