Clinical Study using Urinary Albumin/Creatinine Ratio as an Early Predictor of Prognosis in Critically III Septic Patients

ABSTRACT

Background: Sepsis following surgery or trauma remains one of the leading causes of morbidity and mortality in hospitalpopulations, especially in populations in intensive care units (ICUs). The key to successful control of sepsis-associated infectionsis early prediction and rapid treatment of the disease. Standard clinical and laboratory parameter testing estimate the levels ofexpression of interleukin-1 β (IL-1 β), IL-6, IL-8, and IL-10, tumor necrosis factor-α, FasL (Fas ligand is a type-II transmembraneprotein), and CCL2 (C-C Motif Chemokines Ligand 2) mRNA and growth differentiation factor-15. These are a few measuredby real- time reverse transcriptase polymerase chain reaction.Aim of the Study In this study, evaluation of the urinary albumin/creatinine ratio (ACR) was used as a prognostic predictorin critically ill sepsis patients.Materials and Methods: In a prospective observational study, 365 adult critically septic patients were included. After clinicalevaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission Acute Physiologyand Chronic Health Evaluation (APACHE) IV score and the highest recorded Sepsis-related Organ Failure Assessment (SOFA)score of their daily estimation were considered. The need for mechanical ventilation was assessed in addition to inotropic and/or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality.Observations and Results: A total of 365 patients who were critically ill with sepsis were initially recruited to this study. Thepatients included in this study were aged between 28 and 87 with a mean age of 62.37 ± 9.15 years. There were 235 (64.38%)males and 130 females (35.61%). The highest SOFA score was 7.4 (4.0–14.0) ranging from 1 to 17 and APACHE IV scorerecorded within the first 24 h of ICU admission was 76.8 (58.8–98.0) ranging from 46 to 118. Of 365 patients, 191 (52.32%)required ventilator support, 201 (55.06%) needed inotropic and/or vasoactive support to maintain hemodynamics, and 71(19.45%) needed RRT. The mean length of hospital stay in the present study was 17.65 ± 8.60 days.Conclusions: Evaluating the urinary ACR values regularly in all critically ill sepsis patients was a simple, rapid, non-invasive,inexpensive, easy to perform, and interpret test for early prognosis and prediction of mortality