title: Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients.
abstract: OBJECTIVE
  The study objective was to assess the association between low serum creatinine value at admission and in-hospital mortality in hospitalized patients.
  
  
  METHODS
  This was a retrospective single-center cohort study conducted at a tertiary referral hospital. All hospitalized adult patients between 2011 and 2013 who had an admission creatinine value available were identified for inclusion in this study. Admission creatinine value was categorized into 7 groups: ≤0.4, 0.5 to 0.6, 0.7 to 0.8, 0.9 to 1.0, 1.1 to 1.2, 1.3 to 1.4, and ≥1.5 mg/dL. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to obtain the odds ratio of in-hospital mortality for the various admission creatinine levels, using a creatinine value of 0.7 to 0.8 mg/dL as the reference group in the analysis of all patients and female patients and of 0.9 to 1.0 mg/dL in the analysis of male patients because it was associated with the lowest in-hospital mortality.
  
  
  RESULTS
  Of 73,994 included patients, 973 (1.3%) died in the hospital. The association between different categories of admission creatinine value and in-hospital mortality assumed a U-shaped distribution, with both low and high creatinine values associated with higher in-hospital mortality. After adjustment for age, sex, ethnicity, principal diagnosis, and comorbid conditions, very low creatinine value (≤0.4 mg/dL) was significantly associated with increased mortality (odds ratio, 3.29; 95% confidence interval, 2.08-5.00), exceeding the risk related to a markedly increased creatinine value of ≥1.5 mg/dL (odds ratio, 2.56; 95% confidence interval, 2.07-3.17). The association remained significant in the subgroup analysis of male and female patients.
  
  
  CONCLUSIONS
  Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients.
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.
authors.forename: Charat
authors.initials: C
authors.lastname: Thongprayoon
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.
authors.forename: Wisit
authors.initials: W
authors.lastname: Cheungpasitporn
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn.
authors.forename: Wonngarm
authors.initials: W
authors.lastname: Kittanamongkolchai
authors.affiliation: Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minn.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Harrison
authors.affiliation: Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn. Electronic address: kashani.kianoush@mayo.edu.
authors.forename: Kianoush
authors.initials: K
authors.lastname: Kashani
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D003404:Creatinine
keywords: Creatinine; Discharge disposition; Hospital length of stay; Mortality; Muscle mass