Early and small changes in serum creatinine concentrations are associated with mortality in mechanically ventilated patients.
Emerging evidence suggests that minor changes in serum creatinine concentrations are associated with increased hospital mortality rates. However, whether serum creatinine concentration (SCr) on admission and its change are associated with an increased mortality rate in mechanically ventilated patients is not known. We have conducted an international, prospective, observational cohort study enrolling adult intensive care unit patients under mechanical ventilation (MV). Recursive partitioning was used to determine the values of SCr at the start of MV (SCr0) and the change in SCr ([DeltaSCr] defined as the maximal difference between the value at start of MV [day 0] and the value on MV day 2 at 8:00 am) that best discriminate mortality. In-hospital mortality, adjusted by a proportional hazards model, was the primary outcome variable. A total of 2,807 patients were included; median age was 59 years and median Simplified Acute Physiology Score II was 44. All-cause in-hospital mortality was 44%. The variable that best discriminated outcome was a SCr0 greater than 1.40 mg/dL (mortality, 57% vs. 36% for patients with SCr0 <or=1.40 mg/dL, P < 0.001). Among patients with SCr0 less than or equal to 1.40 mg/dL, DeltaSCr greater than 0.31 discriminated mortality (56% vs. 34%, P < 0.001). In multivariate analysis, geographic area, advanced age, severity of illness, reason for MV, and cardiovascular and hepatic failure were also associated with mortality. Our study suggests that SCr0 greater than 1.40 mg/dL and, in patients with low baseline SCr, a DeltaSCr greater than 0.31 are predictors of in-hospital mortality in mechanically ventilated patients.
Nin
Nicolás
N
Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario de Getafe, Madrid, Spain. niconin@hotmail.com
Lombardi
Raúl
R
Frutos-Vivar
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F
Esteban
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A
Lorente
José A
JA
Ferguson
Niall D
ND
Hurtado
Javier
J
Apezteguia
Carlos
C
Brochard
Laurent
L
Schortgen
Fréderique
F
Raymondos
Konstantinos
K
Tomicic
Vinko
V
Soto
Luis
L
González
Marco
M
Nightingale
Peter
P
Abroug
Fekri
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Pelosi
Paolo
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Arabi
Yaseen
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Moreno
Rui
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Anzueto
Antonio
A
D018806:APACHE; D058186:Acute Kidney Injury / Q000097:blood* / Q000401:mortality*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D016638:Critical Illness / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000401:mortality*
D003404:Creatinine