1. The incidence, characteristics, outcomes and associations of small short-term point-of-care creatinine increases in critically ill patients.
- Author
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Toh L, Bitker L, Eastwood GM, and Bellomo R
- Subjects
- Acute Kidney Injury blood, Adult, Aged, Biomarkers metabolism, Critical Care, Critical Illness, Female, Hospital Mortality, Humans, Incidence, Intensive Care Units, Male, Middle Aged, Prospective Studies, Victoria epidemiology, Acute Kidney Injury mortality, Creatinine metabolism, Point-of-Care Systems
- Abstract
Purpose: We assessed the incidence, characteristics, outcomes and associations of small, short-term point-of-care creatinine increases in critically ill patients., Methods: We prospectively identified the first episode of small (>1 μmol/L/h) short-term (3-4 h) point-of-care creatinine increase between two sequential arterial blood gas measurements. We followed patients for the subsequent development of Kidney Disease: Improving Global Outcomes (KDIGO) defined acute kidney injury (AKI) in the intensive care unit (ICU)., Results: Of 387 patients, 279 (72.1%) developed an episode of small short-term point-of-care creatinine increase and 212 (54.8%) developed AKI. Such episodes occurred at a median of 5 (IQR 2-10) hours after ICU admission, while AKI occurred at a median of 15 (IQR 9-28) hours after admission. Patients with such episodes were more likely to be mechanically ventilated on admission (83.9 vs. 44.4%; p < .001) and had higher hospital mortality (10.9 vs. 3.7%, p = .03). Creatinine increase episodes had a sensitivity of 86% (95% CI 78-95) and specificity of 31% (95% CI 26-36) for subsequent AKI stages 2 and 3 in 24 h., Conclusions: Small, short-term point-of-care creatinine increase episodes are common. They are associated with illness severity, occur early, precede AKI by 10 h and are sensitive rather than specific markers of AKI., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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