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Title: Small, short-term, point-of-care creatinine changes as predictors of acute kidney injury in critically ill patients.
Austin Authors: Toh, Lisa Y;Wang, Alwin R;Bitker, Laurent;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia
The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Department of Critical Care, The University of Melbourne, Melbourne, Australia
Intensive Care
Data Analytics Research and Evaluation, Austin Hospital and University of Melbourne, Melbourne, Australia
Université de Lyon, CREATIS CNRS UMR5220 INSERM U1044 INSA, Lyon, France..
Issue Date: Oct-2022
Date: 2022
Publication information: Journal of Critical Care 2022; 71: 154097
Abstract: To assess short-term creatinine changes as predictors of acute kidney injury (AKI) when used alone and in combination with AKI risk factors. In this prospective cohort study, we identified all creatinine measurements from frequent point-of-care arterial blood gas measurements from ICU admission until AKI. We evaluated the predictive value of small changes between these creatinine measurements for AKI development, alone and with AKI risk factors. Of 377 patients with 3235 creatinine measurements, generating 15,075 creatinine change episodes, 215 (57%) patients developed AKI, and 68 (18%) developed stage 2 or 3 AKI. In isolation, a creatinine increase over 4.1-7.3 h had a 0.65 area under the curve for predicting stage 2 or 3 AKI within 3-37.7 h. Combining creatinine increases of ≥1 μmol/L/h (≥0.0113 mg/dL/h) over 4-5.8 h with three AKI risk factors (cardiac surgery, use of vasopressors, chronic liver disease) had 83% sensitivity, 79% specificity and 0.87 area under the curve for stage 2 or 3 AKI occurring 8.7-25.6 h later. In combination with key risk factors, frequent point-of-care creatinine assessment on arterial blood gases to detect small, short-term creatinine changes provides a robust, novel, low-cost, and rapid method for predicting AKI in critically ill patients.
DOI: 10.1016/j.jcrc.2022.154097
Journal: Journal of Critical Care
PubMed URL: 35716650
Type: Journal Article
Subjects: Acute kidney injury
Arterial blood gases
Critical care
Intensive care
Point-of-care testing
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