PERFORMANCE OF SERUM CREATININE AND URINE OUTPUT IN THE DIAGNOSIS OF ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS: SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Acute Kidney Injury (AKI) affects more than 40% of patients in intensive care units (ICU), increasing morbidity, and mortality. Diagnosis is made using serum creatinine levels and urinary output (UO). However, the diagnostic yield of each individual approach is not well known. We aimed to compare the diagnostic performance of creatinine versus UO for AKI in critically-ill patients. METHODS: Systematic review (SR) using MEDLINE, EMBASE, LILACS, and the Cochrane Library databases without language restriction. All studies that evaluated the diagnostic accuracy of creatinine and UO for the diagnosis of AKI in adult ICU patients were initially included. Original data for study design, population inclusion, measurement and timing of AKI occurrence, bio-marker performance, and bias risk was extracted. UO was used as the index test and serum creatinine as the reference test. For the meta-analysis, KDIGO criteria were used as the diagnostic gold standard construct. RESULTS: 12 studies were included in the SR and 4 studies in the meta-analysis, for a total of 36,309 patients. Sensitivity and specificity of UO versus creatinine were evaluated in 4 studies based on the KDIGO definition, finding a sensitivity of 0.66 [95% CI 0.51 - 0.78] and a specificity of 0.65 [95% CI 0.48 - 0.79]. The diagnostic odds ratio (OR) for UO was 4 (95% CI:3-5), positive likelihood ratio (LR +) was 1.89 (95% CI:1.4-2.51), and LR - was 0.53 (95% CI: 0.44-0.63) and an area under the ROC curve of 0.70.Patients identified by UO were more likely to be falsely classified as false positives, which led us to compare both tools against the construct finding a sensitivity for UO of 0.80 (95% CI 0.70 - 0.87) and for creatinine levels of 0.59 (95% CI 0.54 - 0.65) CONCLUSIONS: In critically-ill patients, urine output is the most sensitive criteria among the ones used by the KDIGO definition. UO monitoring is a simple, inexpensive and widely available tool, given its high sensitivity, emphasizing its strict use could allow for earlier detection of AKI in critically ill patients. CLINICAL IMPLICATIONS: Urine output changes are able to detect more cases of AKI in critically ill patients than serum creatinine levels when used individually. DISCLOSURES: No relevant relationships by Diana Buitrago, source=Web Response No relevant relationships by Maite Hurtado, source=Web Response No relevant relationships by Gabriel Ortiz Jaimes, source=Web Response Employee relationship with Rts Baxter Please note: $5001 - $20000 Added 06/01/2020 by Maria Jose Vargas, source=Web Response, value=Salary