Urinary Albumin/Creatinine Ratio as an Early Predictor of Outcome in Critically Ill Patients

ABSTRACT

Background: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.So sensitive, inexpensive and dynamic prognostic markers which generate rapid and reliable results are therefore desirable in the ICU setting. Objectives: 1.‟ To evaluate microalbumin to creatinine ratio within 6 hours of ICU admission and after 24 hours of ICU admission. 2. To correlate microalbumin to creatinine ratio with APACHE II score to predict outcome in critically ill patients”. Methods: In this prospective non-interventional study, 98 adult patients admitted to I.C.U. with more than 24 hours of ICU stay were included and Spot urine sample collected at 6, 24 hours of admission to medical ICU ward. Sample will be tested for urine microalbumin by immunoturbidometric method and urinary creatinine was measured by calorimetric method. Albumin creatinine ratio was measured. For disease prognosis scoring, GCS, SOFA and APACHE II scores were calculated simultaneously. Results:Prevalence of ACR at 6 hrs 95.7%, 97.9% at 24 hrs. Out of 98 patients 47 patients died.p value <0.001. Among the survivors there was a significant correlation between decreasing microalbuminuria, microalbumin to creatinine ratio level and decreasing APACHE II and SOFA scores, and increasing GCS score, p- value being 0.0011, 0.002 and 0.0005 respectively. Among the non-survivors there was a significant correlation between increasing microalbuminuria, to creatinine ratio level and increasing APACHE II and SOFA scores, and decreasing GCS score, p value being 0.0001, 0.0001 and 0.0001 respectively.Conclusion: This study was carried out to find out the role of microalbuminuria, microalbumin to creatinine ratio as a predictor of prognosis in critically ill patients as compared to standard scoring methods like the Glasgow coma scale, APACHE II and SOFA scores. Hence microalbumin to creatinine ratio at 24 hours may be considered as a predictor of outcome in critically ill patients.