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Original Research |

Intensive Monitoring of Urine Output is Associated with Increased Detection of Acute Kidney Injury and Improved Outcomes OPEN ACCESS

Kui Jin, MD; Raghavan Murugan, MD, MS; Florentina E. Sileanu, MS; Emily Foldes, MS; Priyanka Priyanka, MS; Gilles Clermont, MD, MS; John A. Kellum, MD
Author and Funding Information

1The Center for Critical Care Nephrology. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, and University of Pittsburgh Medical Center, Pittsburgh, PA

2The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center. Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA

Corresponding Author: John A. Kellum MD, MCCM Professor of Critical Care Medicine, Medicine, Bioengineering, and Translational & Clinical Science Director, Center for Critical Care Nephrology 604 Scaife Hall 3550 Terrace Street Pittsburgh, PA 15261.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.05.011
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Abstract

Background  Urine output (UO) is a vital sign for critical ill patients but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if intensity of UO monitoring is associated with outcomes in patients with and without AKI.

Methods  Retrospective cohort study including 15,724 adults admitted to ICUs from 2000-2008. Intensive UO monitoring was defined as hourly recordings and no gaps >3 hours for the first 48 hours after ICU admission.

Results  4,049 (26%) patients underwent intensive monitoring for UO and we found significantly higher rates of AKI (OR 1.22 p<0.001) in these patients. After adjustment of age and severity of illness, intensive UO monitoring was associated with improved survival, but only among patients developing AKI. With or without AKI, patients with intensive monitoring also had less cumulative fluid volume (2.98L vs. 3.78L, p<0.001) and less fluid overload (2.49% vs. 5.68%, p <0.001) over the first 72 hours of ICU stay.

Conclusion  In this large ICU population, intensive monitoring of UO was associated with improved detection of AKI and reduced 30-day mortality in patients developing AKI; as well as less fluid overload for all patients. Our results should help inform clinical decisions and ICU policy around frequency of monitoring of UO especially for patients at high risk of AKI and/or fluid overload.


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