| Objective To explore the clinical value of urinary albumin/creatinine ratio(uACR)in predicting diagnosis and prognosis of acute kidney injury(AKI)in adult critically ill patients.Participants and Methods The present prospective observational study was conducted in the adult general intensive care units(ICUs)of three different tertiary care hospitals in China.All consecutive patients between October 2014 and May 2015 were eligible for enrollment.The exclusion criteria included age under 18 years,pregnancy,refusal of consent,end-stage renal disease(ESRD),history of chronic dialysis,preexisting dialysis before ICU admission,and organ transplantation nearly one year.Patients were excluded from the study if they died or were discharged within 24h of ICU admission,or missing admission data.According to the exclusion criteria,527 patients were enrolled in the analysis.Serum creatinine(sCr)was measured at ICU admission and thereafter at least once daily as a part of routine clinical care during ICU hospitalization.The hourly urine output from enrollment to ICU discharge was also recorded.According to the Kidney Disease Improving Global Outcomes(KDIGO)criterion(2012),which was defined as an increase in sCr by ≥0.3mg/dl(≥26.5μmol/L)within 48h or increase in sCr to ≥1.5 times baseline within 1 week after admission,or urine output<0.5ml/kg/h for 6h.Based on the baseline value of sCr,the baseline estimated glomerular filtration rate(eGFR)was estimated by the simplified Modification of Diet in Renal Disease(MDRD)formula.The patients were divided into AKI group and non-AKI group.AKI group was divided into Mild AKI(KDIGO stage 1)and severe AKI(KDIGO stage 2 or stage 3)within 1 week after ICU admission.The levels of uACR from different groups were measured and compared.By using the receiver operating characteristic(ROC)curve and the area under curve(AUC)to evaluate the clinical value of uACR in diagnosis,progression and prognosis of AKI.A P<0.05 was considered to indicate statistical significance.Results 1.There were 148 AKI patients in 527 cases of critically ill patients(28.1%).Compared with the non-AKI patients,the patients with AKI were significantly older and had higher rate of preexisting clinical conditions,such as diabetes mellitus,hypertension,and coronary artery disease(P<0.001).The incidence of AKI in internal medicine cohort and emergency surgery patients was apparently higher than elective surgery patients(P<0.001).Patients with AKI had higher Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)scores at ICU admission.AKI group showed significantly higher renal replacement therapy(RRT)require rate during ICU stay,ICU mortality rate and in-hospital mortality rate than non-AKI group(P<0.001).AKI group also showed significantly longer length of ICU stay and hospital stay(P<0.001).2.Of 148 patients with AKI,54 had severe AKI(10.2%).AKI cases had higher level of uACR than non-AKI cases(P<0.001).The levels of sCr and uACR were higher in mild AKI group than non-AKI group(P<0.05).The levels of eGFR were lower in mild AKI group than non-AKI group(P<0.05).The levels of sCr and uACR were significantly higher in severe AKI than in non-AKI or mild AKI.The levels of eGFR were significantly lower in severe AKI group than in non-AKI group or mild AKI group(P values of sCr and eGFR<0.001,P value of uACR<0.05).3.The AUC-ROC values of uACR for total AKI and severe AKI after ICU admission were 0.706 and 0.748,respectively,which demonstrated moderate predictive ability.4.The AUC-ROC value of uACR for established AKI was 0.702,which demostrated moderate predictive ability.The AUC-ROC values of uACR for required dialysis in ICU,in-ICU mortality and in-hospital mortality prediction were 0.851,0.781,0.748,respectively.uACR demonstrated better predicted value of renal replacement therapy in ICU than APACHE II score.Conclusions uACR has capability in predicting diagnosis and prognosis of AKI in adult critically ill patients,which is a biomarker for early diagnosis and prognosis evaluation of AKI. |
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