Austin Health

Title
The incidence, characteristics, outcomes and associations of small short-term point-of-care creatinine increases in critically ill patients.
Publication Date
2019-08
Author(s)
Toh, Lisa
Bitker, Laurent
Eastwood, Glenn M
Bellomo, Rinaldo
Subject
Acute kidney injury
Adult
Creatinine
Critical illness
Intensive care unit
Point-of-care testing
Type of document
Journal Article
OrcId
0000-0002-1650-8939
DOI
10.1016/j.jcrc.2019.05.007
Abstract
We assessed the incidence, characteristics, outcomes and associations of small, short-term point-of-care creatinine increases in critically ill patients. We prospectively identified the first episode of small (>1 μmol/L/h) short-term (3-4 h) point-of-care creatinine increase between two sequential arterial blood gas measurements. We followed patients for the subsequent development of Kidney Disease: Improving Global Outcomes (KDIGO) defined acute kidney injury (AKI) in the intensive care unit (ICU). Of 387 patients, 279 (72.1%) developed an episode of small short-term point-of-care creatinine increase and 212 (54.8%) developed AKI. Such episodes occurred at a median of 5 (IQR 2-10) hours after ICU admission, while AKI occurred at a median of 15 (IQR 9-28) hours after admission. Patients with such episodes were more likely to be mechanically ventilated on admission (83.9 vs. 44.4%; p < .001) and had higher hospital mortality (10.9 vs. 3.7%, p = .03). Creatinine increase episodes had a sensitivity of 86% (95% CI 78-95) and specificity of 31% (95% CI 26-36) for subsequent AKI stages 2 and 3 in 24 h. Small, short-term point-of-care creatinine increase episodes are common. They are associated with illness severity, occur early, precede AKI by 10 h and are sensitive rather than specific markers of AKI.
Link
Citation
Journal of Critical Care 2019; 52: 227-232
Jornal Title
Journal of Critical Care

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