1PhD. Student (Med. Biochemistry), S.B.K.S Medical Institute & Research Centre, Sumandeep Vidyapeeth, Piparia, Vadodara
2Professor & Head, Biochemistry Dept., Baroda Medical College, Vadodara
3Tutor, Pathology Dept., Baroda Medical College, Vadodara
4Professor & Head, Biochemistry Dept., S.B.K.S Medical Institute & Research Centre, Sumandeep Vidyapeeth, Piparia, Vadodara
5Resident, Biochemistry Dept., S.B.K.S Medical Institute & Research Centre, Sumandeep Vidyapeeth, Piparia, Vadodara
*Corresponding Author: E-mail:- patel_bhavita2007@yahoo.co.in
Online published on 22 May, 2014.
In Critical care units, prediction of outcome is of vital importance to the clinician. It allows planning of early therapeutic intervention and appropriate counseling of patient. Prognostic measures used in ICU should ideally detect short term changes in critical illnesses and also reflect impact of early therapeutic interventions on the outcome of patient. So sensitive, inexpensive and dynamic prognostic markers which generate rapid and reliable results are therefore desirable in the ICU setting.
The goal of our study is to evaluate Microalbumin to Creatinine ratio within 6 hours of ICU admission (ACR1) and after 24 hours (ACR2) of ICU admission and to correlate Microalbumin to Creatinine ratio with the APACHE-II score to predict outcome in critically ill patients.
In this prospective non-interventional study, 100 adult patients admitted to M.I.C.U and S.I.C.U with more than 24 hours of ICU stay were included and after their informed consent, blood and urine samples were collected on admission to ICU and 24 hours thereafter. Urine microalbumin to creatinine ratio (ACR1) was measured on admission and after 24 hours of ICU admission. For disease severity scoring, APACHE II scores were calculated.
Out of 100 patients, 82 survived while 18 patients died in ICU. Non-survivors had significantly higher median ACR2 [164.5 mg/g (IQR 104.9–172.1)] in comparison to the survivors who had a median ACR2 [46.0 mg/g (IQR 25.6–89.4)] (P<0.0001). The median ACR1 [161.5 mg/g (IQR 105.3–180.8)] of non-survivors was also significantly higher than median ACR1 of survivors [89.8 mg/g (IQR 28.7–101.3)] (P<0.0001). In a receiver operating characteristic curve (ROC) analysis, ACR2 merged as the best indicator of mortality [area under curve (AUC) of ACR2 = 0.85> AUC of ACR1 = 0.81> AUC of ΔACR = 0.61] similar to the currently used APACHE II scores (AUC = 0.90). At a cut off of 101 mg/g, ACR2 had sensitivity of 83.3%, specificity 79.7%, positive predictive value of 48.3% and negative predictive value of 95.4% for predicting mortality in critically ill patients.
Microalbuminuria at 24 hrs of ICU admission had a good sensitivity and specificity to predict mortality equivalent to APACHE II scores and could be effectively utilized to predict survival in the ICU.
Critically ill, intensive care unit, Microalbuminuria, mortality, outcome
