Acute kidney injury detection with additional point-of-care creatinine vs central laboratory serum creatinine measurement in critically ill patients

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2025-03-06 DOI:10.1016/j.jcrc.2025.155050

Kyle C. White , Jason Meyer , Kevin B. Laupland , Siva Senthuran , Kiran Shekar , James McCullough , Rinaldo Bellomo , On behalf of the Queensland Critical Care Research Network (QCRCN)

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引用次数: 0

Abstract

Background

Serum creatinine measured by point-of-care testing (CrP) correlates with central laboratory serum creatinine (CrC) measurement and can be performed frequently, which might lead to an earlier diagnosis of acute kidney injury (AKI). We aimed to test whether the combination of CrP and CrC measurement would achieve earlier and more freuent AKI diagnosis than routine CrC testing alone.

Methods

Retrospective study of critically ill patients with two or more CrP measurements 24 h before an AKI was diagnosed on CrC.

Results

1591 patients with a median APACHE 3 score of 67 (IQR 52-85) and a median number of CrP of 5 (IQR 3-6) measurements. The median individual differences in time to AKI diagnosis between CrC and CrP was −5 h (−11-−1). As the number of point-of-care tests increased in the 24 h before CrC-defined AKI diagnosis, the difference in hours increased (−3 (IQR −6-−1) to −8 (IQR −13– −2); p < 0.001). Compared to CrC alone, the use of both CrC and CrP detected more increases in AKI severity to each AKI stage (stage 1: 1767 (34 %) vs 1.170 (30 %); stage 2: 1.301 (25 %) vs 809 (21 %) and stage 3: 2071 (40 %) vs 1920 (49 %); p < 0.001).

Conclusion

Combined with CrC, CrP measurement resulted in the earlier diagnosis of AKI during ICU admission. Compared to CrC alone, using CrP measurements in combination with CrC was also associated with a higher maximum AKI stage and more detection of worsening AKI.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.