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Point‐of‐care creatinine measurements to predict acute kidney injury
Author(s) -
Vaara Suvi T.,
Glassford Neil,
Eastwood Glenn M.,
Canet Emmanuel,
Mårtensson Johan,
Bellomo Rinaldo
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13564
Subject(s) - medicine , acute kidney injury , creatinine , receiver operating characteristic , renal function , logistic regression , renal replacement therapy , area under the curve , retrospective cohort study , critically ill
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 (Cr F ) and identified a Cr value (Cr P ) obtained within 6‐12 hours 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 Cr P 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 Cr P 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.