Urine Output Is Associated With In-hospital Mortality in Intensive Care Patients With Septic Shock: A Propensity Score Matching Analysis.

Tianyang Hu,Zhao Qiao,Ying Mei

doi:10.3389/fmed.2021.737654

Abstract

Background: The relationship between urine output (UO) and in-hospital mortality in intensive care patients with septic shock is currently inconclusive.Methods: The baseline data, UO, and in-hospital prognosis of intensive care patients with septic shock were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. By drawing receiver operating characteristic (ROC) curves and comparing the areas under the ROC curves (AUC) to determine the predictive value of UO for in-hospital mortality, and by drawing the Kaplan-Meier curves to compare the difference in in-hospital mortality between different groups of UO.Results: Before and after the propensity score matching (PSM) analysis, UO was always a risk factor for in-hospital mortality in patients with septic shock. The AUC of UO was comparable to the Sequential Organ Failure Assessment (SOFA) scoring system, while the AUC of combining UO and SOFA was greater than that of SOFA. The median survival time of the high-UO group (UO > 0.39 ml/kg/h, before PSM; UO > 0.38 ml/kg/h, after PSM) was longer than that of the low-UO group. Compared with the high-UO group, the hazard ratios (HR) of the low-UO group were 2.6857 (before PSM) and 1.7879 (after PSM).Conclusions: UO is an independent risk factor for septic shock. Low levels of UO significantly increase the in-hospital mortality of intensive care patients with septic shock. The predictive value of UO is comparable to the SOFA scoring system, and the combined predictive value of the two surpasses SOFA alone.

Highlights

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection
When the timing of continuous renal replacement therapy (CRRT) initiation was stratified by 6 h urine output (UO), 28-day all-cause mortality rates were significantly lower in the non-oliguric group compared with the oliguric group
Huang et al [6] found that reduced initial 24 h UO was associated with an increased risk in 7and 30-day all-cause mortality and major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients admitted without cardiogenic shock and renal dysfunction

Summary

Introduction

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Urine Output and Septic Shock shock was as high as 39% (95% CI: 34.4–43.9%) [4] It is of far-reaching significance to clarify the independent risk factors related to mortality, which can further guide nursing and treatment, so as to achieve the purpose of reducing mortality especially in the intensive care unit (ICU). Zhang et al [7] investigated the relationship between UO on the first day of admission to the ICU and the inhospital mortality of unselected critically ill patients and found that UO was an independent risk factor of mortality regardless of whether diuretics were used or not. The relationship between urine output (UO) and in-hospital mortality in intensive care patients with septic shock is currently inconclusive

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Discussion

Conclusion