Diagnostic accuracy of early urinary index changes in differentiating transient from persistent acute kidney injury in critically ill patients: multicenter cohort study.
Crit Care. 2013 Mar 26;17(2):R56
Authors: Pons B, Lautrette A, Oziel J, Dellamonica J, Vermersch R, Ezingeard E, Mariat C, Bernardin G, Zeni F, Cohen Y, Tardy B, Souweine B, Vincent F, Darmon M
Abstract
INTRODUCTION: Urinary indices have limited effectiveness in separating transient from persistent acute kidney injury (AKI) in ICU patients. Their time-course may vary with the mechanism of AKI. The primary objective of this study was to evaluate the diagnostic value of changes over time of the usual urinary indices in separating transient from persistent AKI. METHODS: Observational prospective multicenter study performed in six ICUs. 244 consecutive patients including 97 without AKI, 54 with transient AKI, and 93 with persistent AKI were included. Urinary sodium, urea and creatinine were measured at ICU admission (H0) and on 6-hour urine samples during the first 24 ICU hours (H6, H12, H18, and H24). Transient AKI was defined as AKI with a cause for renal hypoperfusion and reversal within 3 days. RESULTS: Significant increases from H0 to H24 were noted in fractional excretion of urea (median, 31% [22-41] and 39% [29-48] at H24, P<0.0001], urinary urea/plasma urea (15 [7-28] and 20 [9-40], P<0.0001], and urinary creatinine/plasma creatinine (50 [24-101] and 57 [29-104], P=0.01]. Fractional excretion of sodium did not change significantly during the first 24 hours in the ICU (P=0.13). Neither urinary index values at ICU admission nor changes in urinary indices between H0 and H24 performed sufficiently well to recommend their use in clinical setting (AUC ROC [less than or equal to] 0.65). CONCLUSIONS: Although urinary indices at H24 performed slightly better than those at H0 in differentiating transient from persistent AKI, they remain insufficiently reliable to be clinically relevant.
PMID: 23531299 [PubMed - as supplied by publisher]