Osama Tayeh , Khaled M. Taema , Mohamed I. Eldesouky , Adel A. Omara
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We also evaluated the need for mechanical ventilation, inotropic and/or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality.</p><p>In a population with 63 (55–71) year old with 29 (72.5%) males, we found that the ACR2 is correlated with the SOFA score (<em>r</em> <!-->=<!--> <!-->0.4, <em>P</em> <!-->=<!--> <!-->0.03). SOFA was higher in patients with increasing ACR [14(4.8–16.8) vs 5(3–8), <em>P</em> <!-->=<!--> <!-->0.01]. None of the ACR measures was correlated with APACHE IV score. ACR2 was higher in patients who needed mechanical ventilation and inotropic and/or vasoactive support [140(125–207) and 151(127–218)<!--> <!-->mg/g respectively] compared to [65(47–174) and 74(54–162)<!--> <!-->mg/g], <em>P</em> <!-->=<!--> <!-->0.01 and 0.009. None of the measured parameters was related to the need of RRT. ACR1, ACR2, APACHE IV and increasing ACR were predictors of mortality. The AUC for mortality prediction was largest for APACHE IV (0.90) then ACR2 (0.88). 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None of the ACR measures was correlated with APACHE IV score. ACR2 was higher in patients who needed mechanical ventilation and inotropic and/or vasoactive support [140(125–207) and 151(127–218)<!--> <!-->mg/g respectively] compared to [65(47–174) and 74(54–162)<!--> <!-->mg/g], <em>P</em> <!-->=<!--> <!-->0.01 and 0.009. None of the measured parameters was related to the need of RRT. ACR1, ACR2, APACHE IV and increasing ACR were predictors of mortality. The AUC for mortality prediction was largest for APACHE IV (0.90) then ACR2 (0.88). 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引用次数: 9
摘要
几个繁琐的评分系统被开发用于败血症的预后和预后预测。在这项研究中，我们旨在评估尿白蛋白/肌酐比值(ACR)作为脓毒症的预后预测因子。我们在一项前瞻性观察研究中纳入了40名成年脓毒症患者。我们排除了既往存在慢性肾脏疾病或糖尿病的患者。经临床评估，于患者入院时及入院24 h后采集尿斑标本进行ACR1和ACR2的检测。考虑入院APACHE IV评分和每日估计的最高记录SOFA评分。我们还评估了机械通气、肌力和/或血管活性支持、肾脏替代治疗(RRT)和住院死亡率的需求。在63(55-71)岁人群中，男性29人(72.5%)，我们发现ACR2与SOFA评分相关(r = 0.4, P = 0.03)。ACR越高，SOFA越高[14(4.8 ~ 16.8)vs 5(3 ~ 8)， P = 0.01]。所有ACR指标与APACHE IV评分均无相关性。需要机械通气和肌力和/或血管活性支持的患者的ACR2分别为140(125-207)和151(127-218)mg/g，高于65(47-174)和74(54-162)mg/g, P = 0.01和0.009。测量的参数均与RRT的需要无关。ACR1、ACR2、APACHE IV和ACR升高是死亡率的预测因子。APACHE IV的AUC(0.90)最大，ACR2(0.88)次之。预测死亡率的ACR2为110.5 mg/g，敏感性为100%，特异性为86%。我们认为尿ACR可作为脓毒症患者预后和死亡率预测的简单测试。
Urinary albumin/creatinine ratio as an early predictor of outcome in critically-ill septic patients
Several cumbersome scoring systems were developed for prognosis and outcome prediction in sepsis. We intended in this study to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic predictor in sepsis.
We included 40 adult septic patients in a prospective observational study. We excluded patients with preexisting chronic kidney disease or diabetes mellitus.
After clinical evaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission APACHE IV score and the highest recorded SOFA score of their daily estimation were considered. We also evaluated the need for mechanical ventilation, inotropic and/or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality.
In a population with 63 (55–71) year old with 29 (72.5%) males, we found that the ACR2 is correlated with the SOFA score (r = 0.4, P = 0.03). SOFA was higher in patients with increasing ACR [14(4.8–16.8) vs 5(3–8), P = 0.01]. None of the ACR measures was correlated with APACHE IV score. ACR2 was higher in patients who needed mechanical ventilation and inotropic and/or vasoactive support [140(125–207) and 151(127–218) mg/g respectively] compared to [65(47–174) and 74(54–162) mg/g], P = 0.01 and 0.009. None of the measured parameters was related to the need of RRT. ACR1, ACR2, APACHE IV and increasing ACR were predictors of mortality. The AUC for mortality prediction was largest for APACHE IV (0.90) then ACR2 (0.88). ACR2 of 110.5 mg/g was 100% sensitive and 86% specific to predict mortality.
We concluded that the urinary ACR may be used as a simple test for prognosis and mortality prediction in sepsis.
期刊介绍：
The Egyptian Journal of Critical Care Medicine is the official Journal of the Egyptian College of Critical Care Physicians, the most authoritative organization of Egyptian physicians involved in the multi-professional field of critical care medicine. The journal is intended to provide a peer-reviewed source for multidisciplinary coverage of general acute and intensive care medicine and its various subcategories including cardiac, pulmonary, neuro, renal as well as post-operative care. The journal is proud to have an international multi-professional editorial board in the broad field of critical care that will assist in publishing promising research and breakthrough reports that lead to better patients care in life threatening conditions, and bring the reader a quick access to the latest diagnostic and therapeutic approaches in monitoring and management of critically ill patients.
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