Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome
OBJECTIVES:. To investigate the relationship between oliguric acute kidney injury (AKI) and mortality in patients with acute respiratory distress syndrome (ARDS). DESIGN:. Retrospective cohort study. SETTING:. This investigation took place at a single-center, tertiary referral multidisciplinary comp...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-06-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000000717 |
| _version_ | 1811236925622714368 |
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| author | Raef A. Fadel, DO Ivanna Murskyj, MD Elian Abou Asala, MD Nour Nasiri, MD Ayman Alsaadi, MD Ashley Scott, MD Daniel Ouellette, MD |
| author_facet | Raef A. Fadel, DO Ivanna Murskyj, MD Elian Abou Asala, MD Nour Nasiri, MD Ayman Alsaadi, MD Ashley Scott, MD Daniel Ouellette, MD |
| author_sort | Raef A. Fadel, DO |
| collection | DOAJ |
| description | OBJECTIVES:. To investigate the relationship between oliguric acute kidney injury (AKI) and mortality in patients with acute respiratory distress syndrome (ARDS).
DESIGN:. Retrospective cohort study.
SETTING:. This investigation took place at a single-center, tertiary referral multidisciplinary comprehensive healthcare hospital in metropolitan Detroit, Michigan.
PATIENTS:. Adult patients 18 years old or older hospitalized in the ICU and diagnosed with ARDS on mechanical ventilation.
INTERVENTIONS:. None.
MEASUREMENTS AND MAIN RESULTS:. Three hundred eight patients were included in the final analysis. Risk factors associated with mortality included advanced age (p < 0.001), increased body mass index (p = 0.008), and a history of chronic kidney disease (p = 0.023). Presence of AKI by day 1 of intubation, with elevated creatinine (p = 0.003) and oliguria (p < 0.001), was significantly associated with mortality. On multivariate analysis, advanced age (relative risk [RR], 1.02), urine output on the day of intubation (RR, 0.388), bicarbonate level (RR, 0.948), and Sequential Organ Failure Assessment severity score (RR, 1.09) were independently associated with mortality. A receiver operating characteristic curve identified a threshold urine output on the day of intubation of 0.7 mL/kg/hr (area under the curve, 0.75; p < 0.001) as most closely associated with inpatient mortality (i.e., urine output < 0.7 mL/kg/hr is associated with mortality).
CONCLUSIONS:. For patients with ARDS, oliguria on the day of intubation was independently associated with increased mortality. Urine output of less than 0.7 mL/kg/hr predicted 80% of inpatient deaths. These findings herald an augmented understanding of the role of urine output in medical decision-making and prognostication. |
| first_indexed | 2024-04-12T12:16:29Z |
| format | Article |
| id | doaj.art-2f6c5f46bc0a4897a7348b20141445b6 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-12T12:16:29Z |
| publishDate | 2022-06-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-2f6c5f46bc0a4897a7348b20141445b62022-12-22T03:33:24ZengWolters KluwerCritical Care Explorations2639-80282022-06-0146e071710.1097/CCE.0000000000000717202206000-00014Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress SyndromeRaef A. Fadel, DO0Ivanna Murskyj, MD1Elian Abou Asala, MD2Nour Nasiri, MD3Ayman Alsaadi, MD4Ashley Scott, MD5Daniel Ouellette, MD61 Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.1 Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.1 Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.1 Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.1 Department of Internal Medicine, Henry Ford Hospital, Detroit, MI.2 Department of Pulmonary and Critical Care Medicine, University of Arizona, Tucson, AZ.3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.OBJECTIVES:. To investigate the relationship between oliguric acute kidney injury (AKI) and mortality in patients with acute respiratory distress syndrome (ARDS). DESIGN:. Retrospective cohort study. SETTING:. This investigation took place at a single-center, tertiary referral multidisciplinary comprehensive healthcare hospital in metropolitan Detroit, Michigan. PATIENTS:. Adult patients 18 years old or older hospitalized in the ICU and diagnosed with ARDS on mechanical ventilation. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Three hundred eight patients were included in the final analysis. Risk factors associated with mortality included advanced age (p < 0.001), increased body mass index (p = 0.008), and a history of chronic kidney disease (p = 0.023). Presence of AKI by day 1 of intubation, with elevated creatinine (p = 0.003) and oliguria (p < 0.001), was significantly associated with mortality. On multivariate analysis, advanced age (relative risk [RR], 1.02), urine output on the day of intubation (RR, 0.388), bicarbonate level (RR, 0.948), and Sequential Organ Failure Assessment severity score (RR, 1.09) were independently associated with mortality. A receiver operating characteristic curve identified a threshold urine output on the day of intubation of 0.7 mL/kg/hr (area under the curve, 0.75; p < 0.001) as most closely associated with inpatient mortality (i.e., urine output < 0.7 mL/kg/hr is associated with mortality). CONCLUSIONS:. For patients with ARDS, oliguria on the day of intubation was independently associated with increased mortality. Urine output of less than 0.7 mL/kg/hr predicted 80% of inpatient deaths. These findings herald an augmented understanding of the role of urine output in medical decision-making and prognostication.http://journals.lww.com/10.1097/CCE.0000000000000717 |
| spellingShingle | Raef A. Fadel, DO Ivanna Murskyj, MD Elian Abou Asala, MD Nour Nasiri, MD Ayman Alsaadi, MD Ashley Scott, MD Daniel Ouellette, MD Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome Critical Care Explorations |
| title | Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome |
| title_full | Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome |
| title_fullStr | Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome |
| title_full_unstemmed | Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome |
| title_short | Oliguria on the Day of Intubation Is Associated With Mortality in Patients With Acute Respiratory Distress Syndrome |
| title_sort | oliguria on the day of intubation is associated with mortality in patients with acute respiratory distress syndrome |
| url | http://journals.lww.com/10.1097/CCE.0000000000000717 |
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