PURPOSE: Malnutrition reduces the ability to fight critical illness. Low baseline serum creatinine (BSC)is a better surrogate marker of low muscle mass than a low body mass index (BMI) and has been associated with poor outcome in some patient populations. We hypothesized that low BSC would be associated with poor outcome in the critically ill.
METHODS: Retrospective cohort study, data including demographics,post operative status, and Acute Physiology and Chronic Health Evaluation (APACHE) III scores were collected from the institutional APACHE III database. The main outcomes measured were hospital mortality and intensive care unit (ICU) length of stay (LOS). Consecutive critically ill patients >18 years of age admitted to three ICUs of two tertiary care hospitals from January 2003 to December 2006, were included in the study. We excluded those who denied research authorization, did not have a BSC measured, pregnancy, had a history of chronic renal replacement, or were admitted for low risk monitoring only.
RESULTS: Of 11291 patients who met the inclusion criteria, 1185 (10%) died in the hospital. There were 54% male patients, 90% were Caucasian, mean age (±SD) was 63± 17; median BMI was 27.3 (interquartile range [IQR] 23.5-32.1), median APACHE III score was 53 (IQR 38-69), and median BSC was 1.1 (IQR 0.9-1.4). When adjusted for APACHE III predicted mortality, age, gender, postoperative state and BMI; low baseline creatinine was associated with increased mortality in a dose-response manner: odds ratio 2.59 (95% confidence interval (CI), 1.82-3.61) for baseline creatinine ≤;0.6 mg/dL (p<0.001); and odds ratio 1.28 (95% CI, 1.03 to 1.60) for baseline creatinine 0.6-0.8 mg/dL (p=0.023). Adjusted ICU LOS in survivors was 0.48 days (95% CI, 0 to 0.98) longer in patients with baseline creatinine ≤;0.6 mg/dL (p=0.058).
CONCLUSION: Low BSC concentrations are associated with increase risk of mortality in critically ill patients.
CLINICAL IMPLICATIONS: BSC <0.8 mg/dL is an increase risk of poor outcomes in the ICU. It is not known if specific interventions are able to alter poor outcome of these patients.
DISCLOSURE: Rodrigo Cartin-Ceba, No Financial Disclosure Information; No Product/Research Disclosure Information