title: Early and small changes in serum creatinine concentrations are associated with mortality in mechanically ventilated patients.
abstract: 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.
authors.affiliation: Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario de Getafe, Madrid, Spain. niconin@hotmail.com
authors.forename: Nicolás
authors.initials: N
authors.lastname: Nin
authors.forename: Raúl
authors.initials: R
authors.lastname: Lombardi
authors.forename: Fernando
authors.initials: F
authors.lastname: Frutos-Vivar
authors.forename: Andrés
authors.initials: A
authors.lastname: Esteban
authors.forename: José A
authors.initials: JA
authors.lastname: Lorente
authors.forename: Niall D
authors.initials: ND
authors.lastname: Ferguson
authors.forename: Javier
authors.initials: J
authors.lastname: Hurtado
authors.forename: Carlos
authors.initials: C
authors.lastname: Apezteguia
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.forename: Fréderique
authors.initials: F
authors.lastname: Schortgen
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raymondos
authors.forename: Vinko
authors.initials: V
authors.lastname: Tomicic
authors.forename: Luis
authors.initials: L
authors.lastname: Soto
authors.forename: Marco
authors.initials: M
authors.lastname: González
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Fekri
authors.initials: F
authors.lastname: Abroug
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Yaseen
authors.initials: Y
authors.lastname: Arabi
authors.forename: Rui
authors.initials: R
authors.lastname: Moreno
authors.forename: Antonio
authors.initials: A
authors.lastname: Anzueto
mesh_terms: 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*
chemical_list: D003404:Creatinine