title: Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically Ill Patients: A Secondary Analysis of a Multicenter Prospective Cohort Study.
abstract: BACKGROUND
  Urine output (UO) is an essential criterion of the Kidney Disease Improving Global Outcomes (KDIGO) definition and classification system for acute kidney injury (AKI), of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria (KDIGOUO) could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria (KDIGOSCr).
  
  
  METHODS
  We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a 2-month prospective cohort study (July 1, 2009 to August 31, 2009) involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOUOand KDIGOSCr. Hospital mortality of patients with more severe AKI classification based on KDIGOUOwas compared with other patients by univariate and multivariate regression analyses.
  
  
  RESULTS
  The prevalence of AKI increased from 52.4% based on KDIGOSCrto 55.4% based on KDIGOSCrcombined with KDIGOUO. KDIGOUOalso resulted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AKI classification based on KDIGOUO. Compared with non-AKI patients or those with maximum AKI classification by KDIGOSCr, those with maximum AKI classification by KDIGOUOhad a significantly higher hospital mortality of 58.4% (odds ratio [OR]: 7.580, 95% confidence interval [CI]: 4.141-13.873, P< 0.001). In a multivariate logistic regression analysis, AKI based on KDIGOUO (OR: 2.891, 95% CI: 1.964-4.254, P< 0.001), but not based on KDIGOSCr (OR: 1.322, 95% CI: 0.902-1.939, P = 0.152), was an independent risk factor for hospital mortality.
  
  
  CONCLUSIONS
  UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.
authors: Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730; Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
authors: Jun-Ping
authors: JP
authors: Qin
authors: Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, China.
authors: Xiang-You
authors: XY
authors: Yu
authors: Department of Emergency Medicine and Medical Intensive Care Unit, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
authors: Chuan-Yun
authors: CY
authors: Qian
authors: Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
authors: Shu-Sheng
authors: SS
authors: Li
authors: Department of Critical Care Medicine, Guangdong General Hospital, Guangzhou, Guangdong 510080, China.
authors: Tie-He
authors: TH
authors: Qin
authors: Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China.
authors: Er-Zhen
authors: EZ
authors: Chen
authors: Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
authors: Jian-Dong
authors: JD
authors: Lin
authors: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Yu-Hang
authors: YH
authors: Ai
authors: Department of Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China.
authors: Da-Wei
authors: DW
authors: Wu
authors: Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
authors: De-Xin
authors: DX
authors: Liu
authors: Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
authors: Ren-Hua
authors: RH
authors: Sun
authors: Department of Critical Care Medicine, Hebei Medical University Fourth Hospital, Shijiazhuang, Hebei 050011, China.
authors: Zhen-Jie
authors: ZJ
authors: Hu
authors: Department of Critical Care Medicine, Affiliated Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China.
authors: Xiang-Yuan
authors: XY
authors: Cao
authors: Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China.
authors: Fa-Chun
authors: FC
authors: Zhou
authors: Department of Critical Care Medicine, Hainan Provincial People's Hospital, Haikou, Hainan 570311, China.
authors: Zhen-Yang
authors: ZY
authors: He
authors: Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia 010050, China.
authors: Li-Hua
authors: LH
authors: Zhou
authors: Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
authors: You-Zhong
authors: YZ
authors: An
authors: Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
authors: Yan
authors: Y
authors: Kang
authors: Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China.
authors: Xiao-Chun
authors: XC
authors: Ma
authors: Department of Critical Care Medicine, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, China.
authors: Ming-Yan
authors: MY
authors: Zhao
authors: Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China.
authors: Li
authors: L
authors: Jiang
authors: Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
authors: Yuan
authors: Y
authors: Xu
authors: Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730, China.
authors: Bin
authors: B
authors: Du
mesh_terms: D000208:Acute Disease / Q000401:mortality; D000368:Aged; D003404:Creatinine / Q000097:blood; D016638:Critical Illness / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000652:urine*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D003404:Creatinine