title: Point-of-care urine albumin:creatinine ratio is associated with outcome in emergency department patients with sepsis: a pilot study.
abstract: OBJECTIVE
  Sepsis is characterized by an initial systemic proinflammatory response leading to endothelial damage and increased capillary permeability. The authors conducted a pilot study to determine if microalbuminuria, measured by the urine albumin:creatinine ratio (ACR), was associated with outcome in emergency department (ED) sepsis patients.
  
  
  METHODS
  This was an observational cohort study of a convenience sample of adult patients presenting to two EDs over 10 months with sepsis (two or more systemic inflammatory response syndrome [SIRS] criteria and suspected infection). Those who received a urinalysis were prospectively enrolled. Patients with anuria, grossly contaminated specimens, or concurrent noninfectious diagnoses were excluded. Urine ACR was measured on a point-of-care (POC) device. The primary study outcome was ED disposition (three groups): treated and discharged, admitted to the floor, or admitted to the intensive care unit (ICU). Kruskal-Wallis testing was used to compare ACR based on disposition. Variables associated with ACR were identified by Spearman rank correlation or Mann-Whitney rank-sum testing. A post hoc subgroup analysis of patients with and without a genitourinary (GU) source of infection was also performed.
  
  
  RESULTS
  A total of 121 patients were screened, and 29 (24%) were excluded; 92 patients met criteria (mean ± SD age, 51.2 ± 17.0 years; 51 [55%] had severe sepsis, three [3%] had septic shock). There were three in-hospital deaths. Median ACR for patients treated and discharged (n = 22), admitted to floor (n = 50), and admitted to ICU (n = 20) was 2.54 (interquartile range [IQR] = 0.89 to 6.16) versus 2.8 (IQR = 1.69 to 8.8) versus 12.15 (IQR = 4.76 to 20.95), respectively (p = 0.0049). Age, serum creatinine, and GU source of infection were associated with ACR. ACR was significantly associated with disposition among patients without a GU source of infection (p = 0.003), but not among patients with a GU source (p = 0.3744).
  
  
  CONCLUSIONS
  In this pilot study, microalbuminuria measured by POC ACR was associated with disposition in ED patients with sepsis or severe sepsis. Larger studies using more robust outcomes comparing ACR with validated sepsis biomarkers are needed to elaborate on these results.
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, MA, USA. byron.drumheller@gmail.com
authors.forename: Byron C
authors.initials: BC
authors.lastname: Drumheller
authors.forename: Meghan
authors.initials: M
authors.lastname: McGrath
authors.forename: Asako C
authors.initials: AC
authors.lastname: Matsuura
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
mesh_terms: D000328:Adult; D000418:Albumins / Q000032:analysis*; D000419:Albuminuria / Q000175:diagnosis*; D015415:Biomarkers / Q000652:urine; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine*; D004630:Emergencies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011446:Prospective Studies; D018805:Sepsis / Q000652:urine*
chemical_list: D000418:Albumins; D015415:Biomarkers; D003404:Creatinine