Prognostic Value of Urine Albumen/Creatinin Ratio in Sepsis in Critical Care Patients

Abstract

Several scoring systems were developed for prognosis and outcome prediction in sepsis. This study aims to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic predictor in sepsis. The study included 50 adult septic patients in a prospective observational study. Study excluded patients with preexisting chronic kidney disease or diabetes mellitus. After clinical evaluation, urine spot samples were collected on admission and 24 h later for ACR1 and ACR2. Admission APACHE IV score and the highest recorded SOFA score of their daily estimation were considered. This study also evaluated the need for mechanical ventilation, inotropic or vasoactive support, renal replacement therapy (RRT), and in-hospital mortality. In a population with Mean±SD 51.4±16.3 (19-82) year old with 34 (68%) males, we found that the ACR2 is correlated with both APACHE IV and SOFA scores (P <0.001). ACR2 was higher in patients who needed mechanical ventilation and inotropic or vasoactive support [121(21-235) and 166.5(89-235) mg/g respectively] compared to [49(22-120) and 56.5(21-211) mg/g], P <0.001 in both. ΔACR, ACR2, increasing ACR and APACHE IV were predictors of mortality. The AUC for mortality prediction was largest for ΔACR (1), increasing ACR (0.985), ACR2 (0.963) then APACHE IV (0.90). ∆ACR and ACR2 of 91.5 mg/g and -22 was 88.2% & 100% sensitive and 90.9% & 100% specific respectively to predict mortality. We concluded that the urinary ACR might be used as a simple test for prognosis and mortality prediction in sepsis.