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Variability in inpatient serum creatinine; its impact upon short- and long-term mortality.
QJM. 2015 Jan 30;
Authors: Kao SS, Kim SW, Horwood CM, Hakendorf P, Li JY, Thompson CH
Abstract
Background Long staying medical inpatients carry a significant burden of acute and chronic illness. Prediction of their in-hospital and longer-term mortality risk is important. Aim The aim of this study was to determine to what extent creatinine variability predicts in-hospital and one year mortality in inpatients. Design Retrospective cohort analysis. Methods Patients were included if aged 18 years or over and if admitted for seven days or longer. The main outcome variables were mortality in hospital and after discharge. Results Increasing age, the presence of heart failure and a reduced estimated glomerular filtration rate (eGFR) on admission (< 60ml/min/1.73m(2)) all associated with death risk (both in hospital and within a year of discharge). The creatinine change related to mortality risk for the patient whilst in hospital and within one year after discharge independently of these other factors. The threshold of creatinine change, above which the in hospital mortality rose significantly, was 25 μmol/l (p<0.001). A creatinine change of more than 10 μmol/l predicted significantly higher mortality within a year of discharge (p< 0.001). Every 5 μmol/l change in creatinine was associated with an in-hospital mortality increase of 3% (p<0.001) and a one year mortality increase of 1% (p< 0.007). Conclusions Patients with a creatinine rise or fall of over 10 μmol/l during admission are at higher risk of death after discharge than those with a more stable creatinine. These patients therefore merit further attention that might include more focussed nutritional assessment, cardiovascular risk factor management or advance care planning.
PMID: 25636343 [PubMed - as supplied by publisher]