Point-of-care creatinine measurements to predict acute kidney injury

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Vaara , S T , Glassford , N , Eastwood , G M , Canet , E , Mårtensson , J & Bellomo , R 2020 , ' Point-of-care creatinine measurements to predict acute kidney injury ' , Acta Anaesthesiologica Scandinavica , vol. 64 , no. 6 , pp. 766-773 . https://doi.org/10.1111/aas.13564

Title: Point-of-care creatinine measurements to predict acute kidney injury
Author: Vaara, Suvi T.; Glassford, Neil; Eastwood, Glenn M.; Canet, Emmanuel; Mårtensson, Johan; Bellomo, Rinaldo
Contributor organization: HUS Perioperative, Intensive Care and Pain Medicine
Anestesiologian yksikkö
University of Helsinki
Helsinki University Hospital Area
Date: 2020-07
Language: eng
Number of pages: 8
Belongs to series: Acta Anaesthesiologica Scandinavica
ISSN: 0001-5172
DOI: https://doi.org/10.1111/aas.13564
URI: http://hdl.handle.net/10138/326420
Abstract: Abstract Background Plasma creatinine (Cr) is a marker of kidney function and typically measured once daily. We hypothesized that Cr measured by point-of-care technology early after ICU admission would be a good predictor of acute kidney injury (AKI) the next day in critically ill patients. Methods We conducted a retrospective database audit in a single tertiary ICU database. We included patients with normal first admission Cr (CrF) and identified a Cr value (CrP) obtained within 6 to 12 hrs from ICU admission. We used their difference converted into percentage (delta-Cr-%) to predict subsequent AKI (based on Cr and/or need for renal replacement therapy) the next day. We assessed predictive value by calculating area under the receiver characteristic curve (AUC), logistic regression models for AKI with and without delta-Cr-%, and the category-free net reclassifying index (cfNRI). Results We studied 780 patients. Overall, 70 (9.0%) fulfilled the Cr AKI definition by CrP measurement. On day 2, 148 patients (19.0%) were diagnosed with AKI. AUC (95% CI) for delta-Cr-% to predict AKI on day 2 was 0.82 (95% CI 0.78-0.86), and 0.74 (95% CI 0.69-0.80) when patients with AKI based on the CrP were excluded. Using a cut-off of 17% increment, the positive likelihood ratio (95% CI) for delta-Cr-% to predict AKI was 3.5 (2.9 ? 4.2). The cfNRI was 90.0 (74.9-106.1). Conclusions Among patients admitted with normal Cr, early changes in Cr help predict AKI the following day.
Subject: acute kidney injury
critically ill
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: unspecified
Usage restriction: openAccess
Self-archived version: acceptedVersion

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