Predictive Value Of Urinary Microalbumin And LODS For The Prognosis Of Patients With Acute Lung Injury

Objective To investigate the prevalence of microalbuminuria (MAU) in patients with acute lung injury (ALI) and explore the predictive value of urinary microalbumin (MA) and Logistic Organ Dysfunction System (LODS) for the prognosis of the patients with ALI in intensive care unit (ICU).Methods A prospective, observational study was underwent in 51 cases of ALI who admitted to ICU of West China Hospital from September 2004 to February 2005.The relationship between the change of the urinary MA during the first 48 hours (A ACR) with the Lung Injure Score (LIS), Acute Physiology and Chronic Health Evaluation (APACHE) â…¡ score and LODS score was analyzed respectively and the predictive value was compared. The prognostic value of each component of LODS was also compared with each other in a Cox' s proportional hazard model. A stepwise multiple Logistic-regression analysis was used to evaluate the independent role of â–³ACR, platelet counts, serum albumin concentration and lactate dehydrogenase (LDH) level in predicating the death in ICU.Results The prevalence of MAU in those subjects was 99.6%. Patients who had increasing MA during the first 48 hours were at higher risk ofdeath in ICU, and had higher APACHE â…¡ score, LODS score, A LODS score, lower PaO2/FiO2 (OI) . There was significant association of A ACR with APACHE â…¡ score (r=0.412), LODS score (r=0.301), and A LODS score (r=0.627), respectively, but not with LIS score (r=0.046).The area under ROC curve of A ACR, APACHE â…¡ score and LODS score to predicate the death in ICU were 0.859,0.859 and 0.827, respectively. The mortality increased along with the elevation of LODS score. Among the components of LODS except the respiratory system, the score of cardiovascular system demonstrated having the biggest prognostic value in Cox' s proportional hazard model. The multiple Logistic-regression analysis showed the independent predictors of the death in ICU are A ACR and serum albumin concentration at admission.Conclusions The present study reveals a high prevalence of MAU in the patients with ALI in ICU. The increase of urinary MA during the first 48 hours is significantly associated with increasing risk of developing organ failure and death. The mortality in ICU also increases along with the elevation of LODS score. Among the extrapulmonary systems, the LODS score of cardiovascular system has the biggest prognostic value. A ACR is a valuable parameter predictive for the death in ICU as same as APACHE â…¡ score and LODS score.