The Association of Low Admission Serum Creatinine with the Risk of Respiratory Failure Requiring Mechanical Ventilation: A Retrospective Cohort Study

Abstract

To assess the association between low serum creatinine (SCr) value at admission and the risk of respiratory failure requiring mechanical ventilation in hospitalized patients. A retrospective cohort study was conducted at a tertiary referral hospital. All hospitalized adult patients from 2011 through 2013 who had an admission SCr value were included in this study. Patients who were mechanically ventilated at the time of admission were excluded. Admission creatinine was stratified into 7 groups: ≤0.4, 0.5–0.6, 0.7–0.8, 0.9–1.0, 1.1–1.2, 1.3–1.4, and ≥1.5 mg/dL. The primary outcome was the occurrence of respiratory failure requiring mechanical ventilation during hospitalization. Logistic regression analysis was used to assess the independent risk of respiratory failure based on various admission SCr, using SCr of 0.7–0.8 mg/dL as the reference group in the analysis of all patients and female subgroup and of 0.9–1.0 mg/dL in analysis of male subgroup. A total of 67,045 eligible patients, with the mean admission SCr of 1.0 ± 0.4 mg/dL, were studied. Of these patients, 799 (1.1%) had admission SCr of ≤0.4 mg/dL, and 2886 (4.3%) developed respiratory failure requiring mechanical ventilation during hospitalization. The U-curve relationship between admission SCr and respiratory failure during hospitalization was observed, with the nadir incidence of in-hospital respiratory failure in SCr of 0.7–0.8 mg/dL and increased in-hospital respiratory failure associated with both reduced and elevated admission SCr. After adjustment for confounders, very low admission SCr of ≤0.4 mg/dL was significantly associated with increased in-hospital respiratory failure (OR 3.11; 95% CI 2.33–4.17), exceeding the risk related to markedly elevated admission SCr of ≥1.5 mg/dL (OR 1.61; 95% CI 1.39–1.85). The association remained significant in the subgroup analysis of male and female patients. Low SCr value at admission is independently associated with increased in-hospital respiratory failure requiring mechanical ventilation in hospitalized patients.

Serum ionised calcium and the risk of acute respiratory failure in hospitalised patients: a single-centre cohort study in the USA

“…Acute respiratory failure (ARF) is a common and life-threatening condition among hospitalised patients [13][14][15] and is associated with high morbidity and mortality worldwide. [16][17][18][19][20][21][22] Previously, we identified several electrolyte derangements at the time of hospital admission as risk factors for ARF in hospitalised patients. These risk factors included hypophosphataemia or hyperphosphataemia, 20 low serum creatinine, 21 hypoalbuminaemia, 23 hypokalaemia or hyperkalaemia 24 Open access and hypomagnesaemia or hypermagnesaemia.…”

Associations Between Predialysis Creatinine, SOFA Score, and Mortality in Acute Kidney Injury Patients Requiring Dialysis

“…A low creatinine level can relate to an increase in excretion or a decrease in generation. Real kidney function improvement was uncommon in critically ill patients 17 , whereas those patients usually have more complicated underlying problems that affect creatinine generation, such as sepsis 18 , uid accumulation 13 , poor nutrition status and low muscle mass 11,19 , liver failure, and older age 19 . The relationship between low creatinine at the start of RRT and mortality in AKI-D patients was demonstrated in previous reports 5,8 .…”

“…Creatinine is a metabolite of creatine and creatine phosphate, which are in the highest concentration in skeletal muscle, and is mainly eliminated via the kidney 10,11 . Therefore, serum creatinine is used to not only estimate renal function but also to re ect muscle mass.…”

“…Therefore, serum creatinine is used to not only estimate renal function but also to re ect muscle mass. Low serum creatinine is also a marker of malnutrition 11 . However, it is also related to sex, age, diet, and uid status 12,13 .…”

“…Because creatinine is affected by many factors, it usually overestimates renal function in critically ill patients 14 . Studies have shown that low creatinine was associated with high mortality in the ICU and an increased mechanical ventilation use rate and was also a risk marker of mortality in hemodialysis (HD) patients 11,12,15 . Only a few studies with small sample sizes have addressed mortality and the creatinine level in patients with AKI 5,8,13,16 .…”