Fractional excretion of sodium and potassium and urinary strong ion difference in the evaluation of persistent AKI in sepsis

IF 2.7 4区医学 Q2 CRITICAL CARE MEDICINE

Medicina Intensiva Pub Date : 2025-01-01 DOI:10.1016/j.medin.2024.01.004

Nicolás Contrera Rolón , Joaquín Cantos , Iván Huespe , Eduardo Prado , Griselda I. Bratti , Carlos Schreck , Sergio Giannasi , Guillermo Rosa Diez , Carlos F. Varela

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引用次数: 0

Abstract

Objective

To evaluate the diagnostic performance of FENa (Fractional excretion of sodium), FEK (fractional excretion of potassium) and uSID (urinary strong ion difference) in predicting pAKI in sepsis and septic shock.

Design

Retrospective cohort study.

Setting

Two intensive care units in Argentina.

Patients

Adult patients with a confirmed diagnosis of sepsis or septic shock and AKI, and had a urinary biochemistry within 24 h of the AKI diagnosis.

Interventions

None.

Main variables of interest

We evaluated the diagnostic accuracy of FENa, FEK and uSID through a ROC (Receiver Operating Characteristic) curve analysis.

Results

80 patients were included. 40 patients presented pAKI. pAKI group had higher APACHE, SOFA score, and mortality rate. In the ROC curve analysis, uSID had no diagnostic utility (AUC = 0.52, p = 0.69). FENa presented moderate accuracy showing an AUC of 0.71 (95% CI 0.60−0.83; p = 0.001), while FEK presented low accuracy with an AUC of 0.69 (95% CI 0.57−0.80; p = 0.04). The optimal Youden point for identifying pAKI was at a FENa higher than 0.51 % with a specificity of 72.5% and a sensitivity of 65.0%. In the case of FEK, a value higher than 21.9 % presented the best relation, with a specificity of 67.5% and a sensitivity of 65.0%.

Conclusions

urine biochemistry interpretation in septic patients must be revised. FENa and FEK are related to the severity of AKI and could be helpful complementary tools for diagnosing pAKI.

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来源期刊

Medicina Intensiva CRITICAL CARE MEDICINE-

CiteScore

2.70

自引率

20.00%

发文量

146

审稿时长

33 days

期刊介绍： Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).