scholarly journals Validating a Lower Urine Output Criteria in Predicting Death in Critically Ill Patients

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Azrina Md Ralib ◽  
Mohd Basri Mat Nor
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Output ◽  
Moving Average ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Optimal Prediction ◽  
Output Data ◽  
The Ideal

Introduction: Urine output provides a rapid estimate for kidney function, and its use has been incorporated in the diagnosis of acute kidney injury. However, not many studies had validated its use compared to the plasma creatinine. It has been showed that the ideal urine output threshold for prediction of death or the need for dialysis was 0.3 ml/kg/h. We aim to assess this threshold in our local ICU population. Methods: This was a secondary analysis of an observational study done in critically ill patients. Hourly urine output data was collected, and a moving average of 6-hourly urine output was calculated over the first 48 hours of ICU admission. AKIuo was defined if urine output ≤ 0.5 ml/kg/h, and UO0.3 was defined as urine output ≤ 0.3 ml/kg/h. Results: 143 patients were recruited into the study, of these, 87 (61%) had AKIuo, and 52 (36%) had UO0.3. The AUC of AKIuo in predicting death was 0.62 (0.51 to 0.72), and UO0.3 was 0.66 (0.55 to 0.77). There was lower survival in patients with AKIuo and UO0.3 compared to those without (p=0.01, and 0.001, respectively). However, only UO0.3 but not AKIuo independently predicted death (HR 2.44 (1.15 to 5.18). Conclusions: A threshold of 6 hourly urine output of 0.3 ml/kg/h but not 0.5 ml/kg/h independently predictive of death. This support previous finding of a lower threshold of urine output criteria for optimal prediction.

scholarly journals Systemic and Urinary Neutrophil Gelatinase-Associated Lipocalins Are Poor Predictors of Acute Kidney Injury in Unselected Critically Ill Patients

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Annick A. Royakkers ◽  
Catherine S. Bouman ◽  
Pauline M. Stassen ◽  
Joke C. Korevaar ◽  
Jan M. Binnekade ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Observational Cohort Study ◽  
Prospective Observational Cohort Study ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Observational Cohort ◽  
Neutrophil Gelatinase

Background. Neutrophil gelatinase-associated lipocalin (NGAL) in serum and urine have been suggested as potential early predictive biological markers of acute kidney injury (AKI) in selected critically ill patients.Methods. We performed a secondary analysis of a multicenter prospective observational cohort study of unselected critically ill patients.Results. The analysis included 140 patients, including 57 patients who did not develop AKI, 31 patients who developed AKI, and 52 patients with AKI on admission to the ICU. Levels of sNGAL and uNGAL on non-AKI days were significantly lower compared to levels of sNGAL on RIFLERISKdays, RIFLEINJURYdays, and RIFLEFAILUREdays. The AUC of sNGAL for predicting AKI was low: 0.45 (95% confidence interval (CI) 0.27–0.63) and 0.53 (CI 0.38–0.67), 2 days and 1 day before development of AKI, respectively. The AUC of uNGAL for predicting AKI was also low: 0.48 (CI 0.33–0.62) and 0.48 (CI 0.33–0.62), 2 days and 1 day before development of AKI, respectively. AUC of sNGAL and uNGAL for the prediction of renal replacement therapy requirement was 0.47 (CI 0.37–0.58) and 0.26 (CI 0.03–0.50).Conclusions. In unselected critically ill patients, sNGAL and uNGAL are poor predictors of AKI or RRT.

scholarly journals Defining urine output criterion for acute kidney injury in critically ill patients

2010 ◽  
Vol 26 (2) ◽  
pp. 509-515 ◽  
Author(s):  
E. Macedo ◽  
R. Malhotra ◽  
R. Claure-Del Granado ◽  
P. Fedullo ◽  
R. L. Mehta
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Output ◽  
Kidney Injury ◽  
Urine Output Criterion ◽  
Output Criterion

scholarly journals A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients

Critical Care ◽  
2012 ◽  
Vol 16 (5) ◽  
pp. R200 ◽  
Author(s):  
Kama A Wlodzimirow ◽  
Ameen Abu-Hanna ◽  
Mathilde Slabbekoorn ◽  
Robert AFM Chamuleau ◽  
Marcus J Schultz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Output ◽  
Kidney Injury

scholarly journals External validation of urinary C–C motif chemokine ligand 14 (CCL14) for prediction of persistent acute kidney injury

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Sean M. Bagshaw ◽  
Ali Al-Khafaji ◽  
Antonio Artigas ◽  
Danielle Davison ◽  
Michael Haase ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
External Validation ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Urinary Concentration ◽  
Baseline Serum ◽  
Chemokine Ligand

Abstract Background Persistent acute kidney injury (AKI) portends worse clinical outcomes and remains a therapeutic challenge for clinicians. A recent study found that urinary C–C motif chemokine ligand 14 (CCL14) can predict the development of persistent AKI. We aimed to externally validate urinary CCL14 for the prediction of persistent AKI in critically ill patients. Methods This was a secondary analysis of the prospective multi-center SAPPHIRE study. We evaluated critically ill patients with cardiac and/or respiratory dysfunction who developed Kidney Disease: Improving Global Outcomes (KDIGO) stage 2–3 AKI within one week of enrollment. The main exposure was the urinary concentration of CCL14 measured at the onset of AKI stage 2–3. The primary endpoint was the development of persistent severe AKI, defined as  ≥ 72 h of KDIGO stage 3 AKI or death or renal-replacement therapy (RRT) prior to 72 h. The secondary endpoint was a composite of RRT and/or death by 90 days. We used receiver operating characteristic (ROC) curve analysis to assess discriminative ability of urinary CCL14 for the development of persistent severe AKI and multivariate analysis to compare tertiles of urinary CCL14 and outcomes. Results We included 195 patients who developed KDIGO stage 2–3 AKI. Of these, 28 (14%) developed persistent severe AKI, of whom 15 had AKI  ≥ 72 h, 12 received RRT and 1 died prior to  ≥ 72 h of KDIGO stage 3 AKI. Persistent severe AKI was associated with chronic kidney disease, diabetes mellitus, higher non-renal APACHE III score, greater fluid balance, vasopressor use, and greater change in baseline serum creatinine. The AUC for urinary CCL14 to predict persistent severe AKI was 0.81 (95% CI, 0.72–0.89). The risk of persistent severe AKI increased with higher values of urinary CCL14. RRT and/or death at 90 days increased within tertiles of urinary CCL14 concentration. Conclusions This secondary analysis externally validates urinary CCL14 to predict persistent severe AKI in critically ill patients.

scholarly journals Plasma Cystatin C and Estimates of Glomerular Filtration Rate Using Cystatin C Independently Diagnose Acute Kidney Injury in Critically Ill Patients with Sepsis

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Azrina Md Ralib ◽  
Iqbalmunawwir Ab Rashid ◽  
Nur Aisyah Ishak ◽  
Suhaila Nanyan ◽  
Nur Fariza Ramly ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Critically Ill ◽  
Cystatin C ◽  
Clinical Setting ◽  
Critically Ill Patients ◽  
Filtration Rate ◽  
Kidney Injury ◽  
The Ideal

Introduction: Plasma Cystatin C (CysC) is as an early functional marker for acute kidney injury. Estimates of glomerular filtration rate using CysC (eGFRCysC) has been used in some clinical setting. We evaluated the utility of CysC and eGFRCysC in diagnosing acute kidney injury (AKI) and predicting death in critically ill patients with sepsis.  Materials and method: This is an interim analysis of single centre, prospective observational study of critically ill patients. Inclusion criteria were patients older than 18 years old with sepsis and procalcitonin > 0.5ng/ml. Plasma creatinine and CysC were measured on admission, and eGFRCysC. AKI was defined based on the plasma creatinine criteria of the KDIGO guideline.  Results: Thirty one patients were recruited so far, of which 13 (41.9%) had AKI and six died. CysC were higher in patients with AKI versus No AKI (p<0.001), and corresponding eGFRCysC were lower (p=0.006). CysC and eGFRCysC on ICU admission diagnosed AKI with an AUC of 0.88(0.72 to 1.00), and 0.79 (0.62 to 0.96), respectively. Both did not predict death (AUC 0.59 (0.31 to 0.87) and 0.59 (0.31 to 0.86), respectively). After adjusting for age and SOFA score, both CysC and eGFRCysC independently diagnosed AKI (OR 13 (1.5 to 115) and 1.03 (1.01 to 1.06), respectively). The ideal cut-off point for diagnosing AKI for CysC is 1.5 mg/dl (84% sensitivity and 89% specificity) and for eGFRCysC as 77 ml/min (72% sensitivity and 84% specificity).  Conclusion: Plasma CysC and its estimated GFR independently diagnosed AKI in critically ill patients with sepsis. We suggest the ideal cut-off points of 1.5 mg/dl and 77 ml/min which can be used in the clinical setting in this cohort of patients.

The Effect of Serum Neutrophil Gelatinase-Associated Lipocalin on the Discontinuation of Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury

2019 ◽  
Vol 48 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Xiaohan Chen ◽  
Zhiwen Chen ◽  
Tiantian Wei ◽  
Peiyun Li ◽  
Ling Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Urine Output ◽  
Kidney Injury ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Neutrophil Gelatinase

Background: To determine the optimal time for discontinuing continuous renal replacement therapy (CRRT) by evaluating serum neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with acute kidney injury (AKI). Methods: A prospective observational study was conducted from September 2015 to March 2018. AKI patients treated with CRRT for at least 24 h were divided into “success” and “failure” groups according to their RRT requirement within 7 days after the initial discontinuation of CRRT. The prefilter and effluent NGAL concentrations were measured to calculate the sieving coefficient (SC) of NGAL in all included subjects from 0 to 72 h. Results: In total, 110 patients were divided into success (n = 78) and failure groups (n = 32). The mean SC of NGAL during CRRT was less than 0.05. The patients in the failure group were associated with higher mortality compared with patients in the success group (37.5 vs. 12.8%, respectively, p = 0.013). There were significant differences in serum NGAL, creatinine, and urine output at discontinuation. In patients without sepsis (n = 70), serum NGAL and urine output were significant predictors of successful cessation. The area under the receiver operating characteristic to predict the successful discontinuation of CRRT was 0.88 for NGAL and 0.86 for urine output. An NGAL level of 403 ng/mL had the highest sensitivity (81%) and specificity (89%) and a urine output of 695 mL/day had the highest sensitivity (83%) and specificity (88%). However, in septic patients (n = 40), urine output but not serum NGAL (OR 0.999, p = 0.69) was a significant variable (OR 1.002, p = 0.005), with a cutoff of 796 mL/day (sensitivity 83%, specificity 88%). Conclusions: Serum NGAL was a significant factor for predicting successful CRRT discontinuation in nonseptic AKI patients. However, urine output, rather than serum NGAL, was a significant predictor in septic AKI patients.

Sign in / Sign up

Export Citation Format

Share Document