Evaluation of 6-hour urine creatinine clearance as the kidney component in the SOFA score: An observational cohort study

Journal of intensive medicine Pub Date : 2026-02-01 Epub Date: 2025-10-25 DOI:10.1016/j.jointm.2025.08.009

Liran Statlender , Tzippy Shochat , Mzia Moshiashvili , Eyal Robinson , Moran Hellerman Itzhaki , Itai Bendavid , Guy Fishman , Pierre Singer , Ilya Kagan

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Abstract

Background

The Sequential Organ Failure Assessment (SOFA) score, originally designed to reflect disease severity, is now recognized as a prognostic tool for critically ill patients. Recently, calls have emerged to update the score to better align it with contemporary clinical practice.

Methods

This single-center, prospective, observational study was conducted in a general intensive care unit (ICU) of a university-affiliated tertiary hospital from September 10, 2023, to January 7, 2025. Urinary creatinine clearance (CrCl) was calculated daily using 6-h urine collection (CrCl_6h) obtained during the first five nights after admission. Based on CrCl and Kidney Disease: ImprovingGlobal Outcomes (KDIGO) chronic kidney disease criteria, patients were categorized into five groups (0−4), with subsequent calculation of a modified SOFA score according to this grouping. The predictive ability of serum creatinine (Scr), urine output, CrCl_6h, the original SOFA score, and the modified SOFA score for ICU and 90-day mortality was compared by evaluating their area under the receiver operating characteristic (AUROC) values.

Results

A total of 200 patients were included in the study. The ICU mortality for these patients was 12.0% while the 90-day mortality reached 29.5%. Compared with Scr, CrCl_6h displayed significantly higher AUROC values for mortality prediction on almost all days examined. For example, on day 3, the AUROC values were 0.821 vs. 0.730 (P=0.003) for ICU mortality, and 0.760 vs. 0.662 (P=0.002) for 90-day mortality. Similarly, the modified SOFA score showed significantly greater predictive performance on most days assessed. On day 3, the AUROC values were 0.791 vs. 0.706 (P=0.046) for ICU mortality, and 0.741 vs. 0.655 (P=0.007) for 90-day mortality.

Conclusion

The categorization of urinary CrCl based on a 6-h urine collection can improve the ability of the SOFA score for predicting mortality.

Trial Registration: Clinicaltrials.gov Identifier: NCT06779331

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评价6小时尿肌酐清除率作为SOFA评分中的肾脏组成部分：一项观察性队列研究。

背景：序贯器官衰竭评估（SOFA）评分最初用于反映疾病严重程度，现在被认为是危重患者的预后工具。最近，人们呼吁更新评分，以更好地使其与当代临床实践保持一致。方法：本研究于2023年9月10日至2025年1月7日在某大学附属三级医院普通重症监护病房（ICU）进行单中心前瞻性观察性研究。尿肌酐清除率（CrCl）通过入院后前5天每天收集6小时尿液（CrCl6h）来计算。根据CrCl和肾脏疾病：改善全球预后（KDIGO）慢性肾脏疾病标准，将患者分为五组（0-4），随后根据该组计算修改后的SOFA评分。比较血清肌酐（Scr）、尿量、CrCl6h、原SOFA评分、修正SOFA评分对ICU和90天死亡率的预测能力，评价其在受试者操作特征（AUROC）值下的面积。结果：共纳入200例患者。ICU病死率12.0%，90天病死率29.5%。与Scr相比，CrCl6h在几乎所有检测日的死亡率预测中显示出显著更高的AUROC值。例如，第3天ICU死亡率AUROC值为0.821比0.730 (P=0.003)，第90天死亡率AUROC值为0.760比0.662 （P=0.002）。同样，在大多数评估的日子里，修改后的SOFA评分显示出显著更高的预测性能。第3天ICU死亡率AUROC分别为0.791和0.706 (P=0.046)， 90天死亡率AUROC分别为0.741和0.655 （P=0.007）。结论：基于6 h尿液收集的尿CrCl分类可以提高SOFA评分预测死亡率的能力。试验注册：Clinicaltrials.gov标识符：NCT06779331。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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