Urine albumin/creatinine ratio as an early predictor of outcome in critically ill patients with sepsis

Abstract

Background Many scoring systems have been developed for the prognosis and outcome prediction in sepsis, so trying to find a prognostic marker confirming the scoring systems results and predicting outcome is very important to improve patient’s outcome. Objective This study aimed to evaluate the urinary albumin/creatinine ratio (ACR) as a prognostic marker in sepsis. Patients and methods Forty adult patients with sepsis were included in a prospective observational study. Patients with pre-existing chronic kidney disease or Diabetes mellitus were excluded. Clinical evaluation was done first and then urine spot samples were collected on admission and 24 hrs later for ACR1 and ACR2 estimation. Acute physiology and chronic Health Evaluation (APACHE) IV score done on admission and sepsis related organ failure Assessment score, with the highest recorded score of their daily estimation, were considered. The need for mechanical ventilation, inotropic and for vasoactive support, renal replacement therapy and in hospital mortality were also evaluated in our study. Results The mean age of the patients was 63 (55–71) years and 29 (72.5%) were male. We found that the ACR2 is correlated with the sepsis related organ Failure assessment [14 (4.8–16.8) vs 5 (3–8), P=0.01] of the ACR measures, none of them were correlated with APACHE IV Score. In patients who needed mechanical ventilation and inotropic and/or vasoactive support, ACR2 was higher [140 (125–207) and 151 (127–218) mg/gm, respectively] compared with those who did not need [65 (47–174) and 74 (54–162/mg/g], P=0.01 and 0.009. All of the measured parameters were not related to the need of renal replacement therapy. Predictors of mortality were ACR1, ACR2, APACHE IV and increasing ACR. Area under the curve for mortality prediction was largest for APACHE IV (0.90) and the ACR2 (0.88). ACR2 of 110.5 mg/g was 100%. Sensitive and 86% specific to predict mortality. Conclusion Urinary ACR can be used as a simple test for prognosis and mortality prediction in sepsis cases.