Early and small changes in serum creatinine concentrations are associated with mortality in mechanically ventilated patients

Nicolás Nin, Raúl Lombardi, Fernando Frutos-Vivar, Andrés Esteban, José A. Lorente, Niall D. Ferguson, Javier Hurtado, Carlos Apezteguia, Laurent Brochard, Fréderique Schortgen, Konstantinos Raymondos, Vinko Tomicic, Luis Soto, Marco González, Peter Nightingale, Fekri Abroug, Paolo Pelosi, Yaseen Arabi, Rui Moreno, Antonio Anzueto

    Research output: Contribution to journalArticlepeer-review

    24 Scopus citations

    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 ([ΔSCr] 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 SCr 0 greater than 1.40 mg/dL (mortality, 57% vs. 36% for patients with SCr0 ≤1.40 mg/dL, P < 0.001). Among patients with SCr 0 less than or equal to 1.40 mg/dL, ΔSCr 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 ΔSCr greater than 0.31 are predictors of in-hospital mortality in mechanically ventilated patients.

    Original languageEnglish
    Pages (from-to)109-116
    Number of pages8
    JournalShock
    Volume34
    Issue number2
    DOIs
    StatePublished - Aug 2010

    Keywords

    • acute renal failure
    • Mechanical ventilation
    • δ-creatinine

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