Association between early, small creatinine elevation and severe acute kidney injury in critically ill adult patients

ElsevierVolume 72, December 2022, 154142Journal of Critical CareHighlights•

AKI contributes to significant mortality and morbidities in critically ill patients.

The role of small creatinine change (∆SCr) below current AKI criteria is not clear.

A below-AKI ∆SCr within the 48 h of ICU admission is associated with worse outcome.

The association between below-AKI ∆SCr is prominent in patients with baseline SCr <1 mg/dL.

AbstractBackground

Early prediction of AKI is crucial for critically ill patients. We investigated the association between small increase in creatinine and subsequent severe AKI in ICU patients.

Methods

We conducted this retrospective cohort with a multi-institutional database between 2007 and 2019. We included adult patients admitted to the ICU with creatinine changes that did not meet the criteria for AKI diagnosis within 48 h of ICU admission. The outcomes were stage 2 or 3 AKI, kidney replacement therapy, and mortality.

Results

We identified 44,805 patients and divided them into 3 groups by baseline creatinine levels: <1 mg/dL, 1 to 2 mg/dL, and ≥ 2 mg/dL. Compared with patients with higher baseline creatinine levels, patients with normal baseline creatinine levels had fewer comorbidities and less severe condition at ICU admission. The odds ratios of their outcomes increased exponentially with creatinine elevation within the first 48 h of ICU admission. The increasing odds ratios were more prominent in patients with normal baseline creatinine (P for interaction <0.001).

Conclusion

Small creatinine elevation within the first 48 h of ICU admission was strongly associated with the AKI, kidney replacement therapy, and death. This association was more prominent in patients with normal baseline creatinine.

Keywords

Acute kidney injury

Absolute creatinine change

Delta creatinine

Dialysis

Mortality

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