Microalbuminuria: timing is everything!

Gosling, Peter; Manji, Mav; Czyz, John

doi:10.1007/s00134-003-1817-9

Cited by 6 publications

(2 citation statements)

References 5 publications

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“…These studies have all examined risk stratification at or after ICU admission. No previous research has evaluated the prognostic ability of microalbuminuria in the ED during the most proximal phase of critical illness, which is particularly relevant given evidence that microalbuminuria may peak within hours of a proinflammatory insult and have limited significance if measured days after disease onset 9 . Our results parallel those of prior studies showing an association between increasing microalbuminuria and worse outcome in the ICU.…”

Section: Discussionsupporting

confidence: 80%

Point‐of‐care Urine Albumin:Creatinine Ratio Is Associated With Outcome in Emergency Department Patients With Sepsis: A Pilot Study

Drumheller

McGrath

Matsuura

et al. 2012

Academic Emergency Medicine

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ACADEMIC EMERGENCY MEDICINE 2012; 19:259–264 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: 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.

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Section: Discussionsupporting

confidence: 80%

Point‐of‐care Urine Albumin:Creatinine Ratio Is Associated With Outcome in Emergency Department Patients With Sepsis: A Pilot Study

Drumheller

McGrath

Matsuura

et al. 2012

Academic Emergency Medicine

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“… 26 It has been suggested that the timing of evaluation is an important determinant of predictive value of MAU in critically ill patients. 27 , 28 In the present study, the first urine sample for evaluation was collected at the time of admission in the PICU either directly or after catheterization within mean time of 55 minutes (±26 minute).…”

Section: Discussionmentioning

confidence: 99%

Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis

Sachdev

Raheja

Gupta

et al. 2020

Indian Journal of Critical Care Medicine

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Objective The aim of the study was to investigate the association of urinary albumin:creatinine ratio (ACR) with regard to the outcome of sepsis patients and to study the trends of ACR with severity of disease, organ dysfunction, microcirculation status, the use of inotrope, and mechanical ventilation use, and length of pediatric intensive care unit (PICU) stay. Materials and methods In the prospective observational study, the patients with varying categories of sepsis admitted in the PICU with stay >24 hours were enrolled consecutively. Urine samples were collected at the time of admission (ACR1), 12 hours (ACR2), and 24 hours (ACR3). Results One hundred and thirty-eight patients including 56 cases of sepsis, 31 of severe sepsis, 22 of septic shock, and 29 of multiorgan dysfunction syndrome (MODS) cases were analyzed. There were 29 (21%) deaths. ACR (median, IQR) was significantly higher in nonsurvivors [ACR1 198.9 (111.2–329.4) vs 124.5 (59.37–294.5), p 0.03], [ACR2 213.8 (112.5–350) vs 117.8 (62.6–211.9) p 0.008], [ACR3 231.8 (99.9–441.2 vs 114.4 (44.1–240.3), p 0.005]. The ACR is increased progressively with the increasing severity of sepsis ( p < 0.001). The performance of ACR operative characteristics was compared with that of PRISM and PELOD scores. In deceased, ACR was significantly correlated with blood pH, lactate, and base deficit. A cutoff value of ACR 102.7 mg/g had sensitivity 86.2%, specificity 40.4%, positive predictive value 27.8%, and negative predictive value 91.7%. The use of inotropes, mechanical ventilation (>48 hours), and mortality was significantly higher in patients with ACR >102 mg/g. The probability of death varied from 17.6 to 19% in the first 24 hours of admission. ACR was significantly cheaper as compared to PRISM score and PELOD score estimations. Conclusion Urinary ACR, a cost-effective tool, correlates with the severity of sepsis and associated morbidity and mortality in children. How to cite this article Sachdev A, Raheja K, Gupta N, Chugh P. Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis. Indian J Crit Care Med 2020;24(6):465–472.

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Microalbuminuria in severe sepsis: timing is difficult, "normal" levels are uncertain

2003

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Microalbuminuria: timing is everything!

Cited by 6 publications

References 5 publications

Point‐of‐care Urine Albumin:Creatinine Ratio Is Associated With Outcome in Emergency Department Patients With Sepsis: A Pilot Study

Point‐of‐care Urine Albumin:Creatinine Ratio Is Associated With Outcome in Emergency Department Patients With Sepsis: A Pilot Study

Association of Urinary Albumin:Creatinine Ratio with Outcome of Children with Sepsis

Microalbuminuria in severe sepsis: timing is difficult, "normal" levels are uncertain

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