Microalbuminuria does not reflect increased systemic capillary permeability in septic shock.
OBJECTIVE
To investigate the correlation between microalbuminuria and extravascular lung water in patients in septic shock who require mechanical ventilation for severe respiratory failure.


METHODS
Prospective, observational, clinical study in the 20-bed intensive care unit of a university hospital.


METHODS
25 consecutive patients in septic shock and also in severe respiratory failure requiring mechanical ventilation.


METHODS
Hemodynamic parameters and extravascular lung water were determined by single arterial thermodilution. Together with each hemodynamic measurement the PaO(2)/FIO(2) ratio and urinary microalbumin to creatinine ratio (M:Cr) was measured. Serum C-reactive protein (CRP) and procalcitonin (PCT) levels were also determined daily.


RESULTS
The EVLW index was significantly higher than normal throughout the study. Microalbuminuria was in the normal range on entry and remained so for the rest of the study period. Serum PCT and CRP levels were significantly higher than normal at every assessment points. No significant correlation was found between M:Cr and either EVLW or PaO(2)/FIO(2).


CONCLUSIONS
In this study patients in septic shock with significantly elevated EVLW had normal urinary M:Cr, and there was no correlation between M:Cr and EWLV, and PaO(2)/FIO(2). Therefore based on the current results routine measurements of microalbuminuria to determine endothelial permeability cannot be recommended in critically ill patients.
Molnár
Zsolt
Z
Department of Anaesthesiology and Intensive Care, University of Pécs, Pécs, Hungary. z_molnar@hotmail.com
Szakmány
Tamás
T
Heigl
Péter
P
D000368:Aged; D000419:Albuminuria / Q000503:physiopathology*; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002199:Capillary Permeability; D003404:Creatinine / Q000652:urine; D015633:Extravascular Lung Water; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D013815:Thermodilution
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D003404:Creatinine; D015740:Calcitonin Gene-Related Peptide