Oliguria as predictive biomarker of acute kidney injury in critically ill patients

Critical Care

Rinaldo Bellomo⁴  Shigehiko Uchino⁶  Kenji Tsutsui⁶  Claudio Ronco⁵  Dinna Cruz⁵  John A Kellum¹  Anja Haase-Fielitz⁸  Michael Haase⁸  Moritoki Egi²  Sean M Bagshaw³  Elisa Licari⁷  Yan-Lun Liu⁷  John R Prowle⁷ 

[1] The Clinical Research, Investigation, and Systems Modeling of Acute illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA;Department of Anesthesiology and Resuscitology, Okayama University Medical School, 5-1 Shikata-Cho 2-Chome, Okayama 700-8558, Okayama, Japan;Division of Critical Care Medicine, University of Alberta, 3C1.12 Walter C. Mackenzie Centre, 8440-122 Street, Edmonton, AB T6G2B7, Canada;Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 3004 Melbourne, Victoria, Australia;Department Nephrology Dialysis & Transplantation San Bortolo Hospital. International Renal Research Institute (IRRIV), Vicenza, Italy;Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan;Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidleberg, Victoria 3084, Australia;Department of Nephrology and Intensive Care Medicine, Charité University Medicine, 1 Augustenburger Platz, Berlin 13353 Germany

关键词: biomarkers;    urine;    creatinine;    Critical Illness;    Acute;    Kidney Failure;    Oliguria;   

Others  :  1094286
DOI  :  10.1186/cc10318

 received in 2011-02-04, accepted in 2011-07-19,  发布年份 2011

【 摘 要 】

Introduction

During critical illness, oliguria is often used as a biomarker of acute kidney injury (AKI). However, its relationship with the subsequent development of AKI has not been prospectively evaluated.

Methods

We documented urine output and daily serum creatinine concentration in patients admitted for more than 24 hours in seven intensive care units (ICUs) from six countries over a period of two to four weeks. Oliguria was defined by a urine output < 0.5 ml/kg/hr. Data were collected until the occurrence of creatinine-defined AKI (AKI-Cr), designated by RIFLE-Injury class or greater using creatinine criteria (RIFLE-I[Cr]), or until ICU discharge. Episodes of oliguria were classified by longest duration of consecutive oliguria during each day were correlated with new AKI-Cr the next day, examining cut-offs for oliguria of greater than 1,2,3,4,5,6, or 12 hr duration,

Results

We studied 239 patients during 723 days. Overall, 32 patients had AKI on ICU admission, while in 23, AKI-Cr developed in ICU. Oliguria of greater than one hour was significantly associated with AKI-Cr the next day. On receiver-operator characteristic area under the curve (ROCAUC) analysis, oliguria showed fair predictive ability for AKI-Cr (ROCAUC = 0.75; CI:0.64-0.85). The presence of 4 hrs or more oliguria provided the best discrimination (sensitivity 52% (0.31-0.73%), specificity 86% (0.84-0.89%), positive likelihood ratio 3.8 (2.2-5.6), P < 0.0001) with negative predictive value of 98% (0.97-0.99). Oliguria preceding AKI-Cr was more likely to be associated with lower blood pressure, higher heart rate and use of vasopressors or inotropes and was more likely to prompt clinical intervention. However, only 30 of 487 individual episodes of oliguria preceded the new occurrence of AKI-Cr the next day.

Conclusions

Oliguria was significantly associated with the occurrence of new AKI-Cr, however oliguria occurred frequently compared to the small number of patients (~10%) developing AKI-Cr in the ICU, so that most episodes of oliguria were not followed by renal injury. Consequently, the occurrence of short periods (1-6 hr) of oliguria lacked utility in discriminating patients with incipient AKI-Cr (positive likelihood ratios of 2-4, with > 10 considered indicative of a useful screening test). However, oliguria accompanied by hemodynamic compromise or increasing vasopressor dose may represent a clinically useful trigger for other early biomarkers of renal injury.

【 授权许可】

   
2011 Prowle et al.; licensee BioMed Central Ltd.

【 图 表 】

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