Mortality Prediction of Microalbuminuria in Septic Patients
DOI:
https://doi.org/10.3889/oamjms.2019.633Keywords:
ACR, Sepsis, APACHE II, SOFAAbstract
BACKGROUND: Huge number of pro-inflammatory and anti-inflammatory markers is produced during the process of sepsis. Its mortality prediction value needs to be determined.
AIM: To assess the prognostic value of Albumin creatinine ratio (ACR) in septic patients and its ability to predict mortality in comparison with Acute physiology and chronic health evaluation II score (APACHE II).
METHODS: Seventy-five Septic patients were included within 24 hours of sepsis diagnosis and were admitted to the intensive care unit (ICU). ACR values were obtained within 6 hours of ICU admission for all patients. Prognostic scoring systems [APACHE II and Sequential organ failure assessment (SOFA) scores] were calculated.
RESULTS: Twenty percent of enrolled patients died within 28 days of hospital admission. ACR was significantly higher in non-survivor in comparison to survivors (55.1 ± 20.5 versus 30.2 ± 35.7, p = 0.006). ACR ≥ 40 (mg/gm creatinine) was the cut-off point for predicting mortality with a sensitivity of 90.7% and specificity of 71.8% with total accuracy of 66% and AUC 0.75 (CI 0.62-0.88). Mean APACHE II score was significantly higher in non-survivors than survivor groups (21.4 versus 10.8, p < 0.001). ACR was positively correlated with highest SOFA score (r = 0.3, P < 0.05).
CONCLUSION: ACR is a simple prognostic marker in septic patient and could be used as a mortality predictor, particularly in early (within 6 hours) septic patients.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Bone RC, Spiung CL, Sibbaki WS. Definitions for sepsis and organ failure Crit. Care Med. 1992; 19:973-6. https://doi.org/10.1097/00003246-199107000-00024 PMid:1824030
Aird WC. The role of the endothelium in severe sepsis and multiple organ dysfunction syndrome. Blood, J Am Soc Hematol. 2003; 101(10):3765-77. https://doi.org/10.1182/blood-2002-06-1887 PMid:12543869
Ait-Oufella H, Maury E, Lehoux S, Guidet B, Offenstadt G. The endothelium: physiological functions and role in microcirculatory failure during severe sepsis. Intensive Care Med. 2010; 36(8):1286-98. https://doi.org/10.1007/s00134-010-1893-6 PMid:20443110
Mutunga M, Fulton B, Bullock R, Batchelor A, Gascoigne A, Gillespie JI, et al. Circulating endothelial cells in patients with septic shock. Am J Respir Crit Care Med. 2001; 163(1):195-200. https://doi.org/10.1164/ajrccm.163.1.9912036 PMid:11208646
Zhou J, Schmidt M, Johnston B, Wilfart F, Whynot S, Hung O, et al. Experimental endotoxemia induces leukocyte adherence and plasma extravasation within the rat pial microcirculation. Physiol Res. 2011; 60(6):853.
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016; 315(8):801-10. https://doi.org/10.1001/jama.2016.0287 PMid:26903338 PMCid:PMC4968574
Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981; 9(8):591-7. https://doi.org/10.1097/00003246-198108000-00008 PMid:7261642
Vincent J-L, De Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Crit Care Med. 1998; 26(11):1793-800. https://doi.org/10.1097/00003246-199811000-00016 PMid:9824069
Baker T, Schultz MJ, Dünser MW. Critical illness in developing countries: dying in the dark. Lancet. 2011; 377(9775):1405. https://doi.org/10.1016/S0140-6736(11)60572-2
Bakker AJ. Detection of microalbuminuria: Receiver operating characteristic curve analysis favors albumin-to-creatinine ratio aver albumin concentration. Diabetes Care. 1999; 22(2):307. https://doi.org/10.2337/diacare.22.2.307 PMid:10333950
Molnar Z, Szakmány T, Köszegi T, Tekeres M. Microalbuminuria and serum procalcitonin levels following oesophagectomy. Eur J Anaesthesiol. 2000;17(7):464-5. https://doi.org/10.1097/00003643-200007000-00012 PMid:10964152
Gopal S, Carr B, Nelson P. Does microalbuminuria predict illness severity in critically ill patients on the intensive care unit? A systematic review. Crit Care Med. 2006; 34(6):1805-10. https://doi.org/10.1097/01.CCM.0000217922.75068.EA PMid:16625124
Basu S, Bhattacharya M, Chatterjee TK, Chaudhuri S, Todi SK, Majumdar A. Microalbuminuria: a novel biomarker of sepsis. Indian J Crit care Med peer-reviewed, Off Publ Indian Soc Crit Care Med. 2010; 14(1):22. https://doi.org/10.4103/0972-5229.63034 PMid:20606905 PMCid:PMC2888326
De Gaudio AR, Adembri C, Grechi S, Novelli GP. Microalbuminuria as an early index of impairment of glomerular permeability in postoperative septic patients. Intensive Care Med. 2000; 26(9):1364-8. https://doi.org/10.1007/s001340000593 PMid:11089766
Gosling P, Brudney S, McGrath L, Riseboro S, Manji M. Mortality prediction at admission to intensive care: a comparison of microalbuminuria with acute physiology scores after 24 hours. Crit Care Med. 2003; 31(1):98-103. https://doi.org/10.1097/00003246-200301000-00016 PMid:12545001
Bhadade RR, DeSouza R, Harde MJ, Sridhar B, others. Microalbuminuria: a biomarker of sepsis and efficacy of treatment in patients admitted to a medical intensive care unit of a tertiary referral center. J Postgrad Med. 2014; 60(2):145. https://doi.org/10.4103/0022-3859.132320 PMid:24823513
Thorevska N, Sabahi R, Upadya A, Manthous C, Amoateng-Adjepong Y. Microalbuminuria in critically ill medical patients: prevalence, predictors, and prognostic significance. Crit Care Med. 2003; 31(4):1075-81. https://doi.org/10.1097/01.CCM.0000059316.90804.0B PMid:12682475
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2019 Walid Omar, Marwa Elsayed (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)
