title: Cadmium excretion predicting hospital mortality and illness severity of critically ill medical patients.
abstract: OBJECTIVE
  To determine the prognostic value of day 1 urine excretion of cadmium (1st DUE-Cd) for predicting outcomes in intensive care unit (ICU) patients.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  ICUs in Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taiwan, ROC.
  
  
  METHODS
  Two hundred one ICU patients.
  
  
  METHODS
  Urine and blood samples were taken within 24 hours after admission.
  
  
  RESULTS
  Disease severity, hospital mortality, and number of organ failures were evaluated in each medical ICU patient. Stepwise multiple linear regression analysis indicated that a history of chronic hepatitis, serum albumin, and glutamic-pyruvic transaminase were significantly related to 1st DUE-Cd after adjusting for other related variables. Cox multivariate analysis revealed that serum blood urea nitrogen level and ICU 1st DUE-Cd were significantly related to hospital mortality after other risk factors and scoring systems were adjusted. Each 1-microg increase in ICU 1st DUE-Cd was associated with a 7% increase in hospital mortality rate. All patients with poisoning magnitude of cadmium excretion (>10 microg/day) died, except one and those with normal cadmium excretion survived. Chi-square values of the Hosmer-Lemeshow goodness-of-fit test were 6.936 (p = 0.544), and area under the receiver operating characteristic curve was 0.868 (95% confidence intervals: 0.82-0.92) for ICU 1st DUE-Cd.
  
  
  CONCLUSIONS
  The ICU 1st DUE-Cd may predict hospital mortality in critically ill medical patients. Because of excess mortality and relatively small sample size, the predictive role of DUE-Cd needs further external validation.
authors.affiliation: Division of Nephrology and Clinical Toxicology, Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung University and School of Medicine, Taipei, Taiwan, ROC. jllin99@hotmail.com
authors.forename: Ja-Liang
authors.initials: JL
authors.lastname: Lin
authors.forename: Dan-Tzu
authors.initials: DT
authors.lastname: Lin-Tan
authors.forename: Pao-Hsien
authors.initials: PH
authors.lastname: Chu
authors.forename: Yung-Chang
authors.initials: YC
authors.lastname: Chen
authors.forename: Yen-Lin
authors.initials: YL
authors.lastname: Huang
authors.forename: Tai-Chin
authors.initials: TC
authors.lastname: Ho
authors.forename: Chung-Yin
authors.initials: CY
authors.lastname: Lin
mesh_terms: D000368:Aged; D002104:Cadmium / Q000652:urine*; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D002104:Cadmium