The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database
Articolo
Data di Pubblicazione:
2020
Abstract:
Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
Mortality; Renal replacement therapy; Urine output
Elenco autori:
Vincent, J. -L.; Ferguson, A.; Pickkers, P.; Jakob, S. M.; Jaschinski, U.; Almekhlafi, G. A.; Leone, M.; Mokhtari, M.; Fontes, L. E.; Bauer, P. R.; Sakr, Y.; Tomas, E.; Bibonge, E. A.; Charra, B.; Faroudy, M.; Doedens, L.; Farina, Z.; Adler, D.; Balkema, C.; Kok, A.; Alaya, S.; Gharsallah, H.; Muzha, D.; Temelkov, A.; Georgiev, G.; Simeonov, G.; Tsaryanski, G.; Georgiev, S.; Seliman, A.; Vrankovic, S.; Vucicevic, Z.; Gornik, I.; Barsic, B.; Husedzinovic, I.; Pavlik, P.; Manak, J.; Kieslichova, E.; Turek, R.; Fischer, M.; Valkova, R.; Dadak, L.; Dostal, P.; Malaska, J.; Hajek, R.; Zidkova, A.; Lavicka, P.; Starkopf, J.; Kheladze, Z.; Chkhaidze, M.; Kaloiani, V.; Medve, L.; Sarkany, A.; Kremer, I.; Marjanek, Z.; Tamasi, P.; Krupnova, I.; Vanags, I.; Liguts, V.; Pilvinis, V.; Vosylius, S.; Kekstas, G.; Balciunas, M.; Kolbusz, J.; Kubler, A.; Mielczarek, B.; Mikaszewska-Sokolewicz, M.; Kotfis, K.; Tamowicz, B.; Sulkowski, W.; Smuszkiewicz, P.; Pihowicz, A.; Trejnowska, E.; Hagau, N.; Filipescu, D.; Droc, G.; Lupu, M. N.; Nica, A.; Stoica, R.; Tomescu, D. R.; Constantinescu, D. L.; Valcoreanu Zbaganu, G. M.; Slavcovici, A.; Bagin, V.; Belsky, D.; Palyutin, S.; Shlyapnikov, S.; Bikkulova, D.; Gritsan, A.; Natalia, G.; Makarenko, E.; Kokhno, V.; Tolkach, A.; Kokarev, E.; Belotserkovskiy, B.; Zolotukhin, K.; Kulabukhov, V.; Soskic, L.; Palibrk, I.; Jankovic, R.; Jovanovic, B.; Pandurovic, M.; Bumbasirevic, V.; Uljarevic, B.; Surbatovic, M.; Ladjevic, N.; Slobodianiuk, G.; Sobona, V.; Cikova, A.; Gebhardtova, A.; Jun, C.; Yunbo, S.; Dong, J.; Feng, S.; Duan, M.; Xu, Y.; Xue, X.; Gao, T.; Xing, X. Z.; Zhao, X.; Li, C. H.; Gengxihua, G.; Tan, H.; Xu, J.; Jiang, L.; Tiehe, Q.; Bingyu, Q.; Shi, Q.; Lv, Z.; Zhang, L.; Jingtao, L.; Zhen, Z.; Wang, Z.; Wang, T. H.; Yuhong, L.; Zhai, Q.; Chen, Y.; Wang, C.; Jiang, W.; Ruilan, W.; Chen, Y.; Xiaobo, H.; Ge, H.; Yan, T.; Yuhui, C.; Zhang, J.; Jian-Hong, F.; Zhu, H.; Huo, F.; Wang, Y.; Li, C.; Zhuang, M.; Ma, Z.; Sun, J.; Liuqingyue, L.; Yang, M.; Meng, J.; Ma, S.; Kang, Y.; Yu, L.; Peng, Q.; Wei, Y.; Zhang, W.; Sun, R.; Yeung, A.; Wan, W. L.; Sin, K. K. C.; Lee, K. L.; Wijanti, M.; Widodo, U.; Samsirun, H.; Sugiman, T.; Wisudarti, C.; Maskoen, T. T.; Hata, N.; Kobe, Y.; Nishida, O.; Miyazaki, D.; Nunomiya, S.; Uchino, S.; Kitamura, N.; Yamashita, K.; Hashimoto, S.; Fukushima, H.; Adib, N. A. N.; Tai, L. L.; Tony, B.; Bigornia, R. R.; Bigornia, R. R.; Palo, J. E.; Chatterjee, S.; Tan, B. H.; Kong, A.; Goh, S.; Lee, C. -C.; Pothirat, C.; Khwannimit, B.; Theerawit, P.; Pornsuriyasak, P.; Piriyapatsom, A.; Mukhtar, A.; Hamdy, A. N.; Hosny, H.; Ashraf, A.; Mokhtari, M.; Nowruzinia, S.; Lotfi, A. H.; Zand, F.; Nikandish, R.; Moghaddam, O. M.; Cohen, J.; Sold, O.; Sfeir, T.; Hasan, A. Y.; Abugaber, D.; Ahmad, H.; Tantawy, T.; Baharoom, S.; Algethamy, H.; Amr, A.; Almekhlafi, G.; Coskun, R.; Sungur, M.; Cosar, A.; Gucyetmez, B.; Demirkiran, O.; Senturk, E.; Ulusoy, H.; Atalan, H. K.; Serin, S.; Kati, I.; Alnassrawi, Z.; Almemari, A.; Krishnareddy, K.; Kashef, S.; Alsabbah, A.; Poirier, G.; Marshall, J. C.; Herridge, M.; Fernandez-Medero, R.; Fulda, G.; Banschbach, S.; Quintero, J.; Schroeder, E.; Sicoutris, C.; Gueret, R.; Kashyap, R.; Bauer, P.; Nanchal, R.; Wunderink, R. G.; Jimenez, E.; Ryan, A.; Prince, D.; Edington, J.; Van Haren, F.; Bersten, A.; Hawkins, D. J.; Kilminster, M.; Sturgess, D.; Ziegenfuss, M.; O' Connor, S.; Lipman, J.; Campbell, L.; Mcallister, R.; Roberts, B.; Williams, P.; Parke, R.; Seigne, P.; Freebairn, R.; Nistor, D.; Oxley, C.; Young, P.; Valentini, R.; Wainsztein, N.; Comignani, P.; Casaretto, M.; Sutton, G.; Villegas, P.; Galletti, C.; Neira, J.; Rovira, D.; Hidalgo, J.; Sandi, F.; Caser, E.; Thompson, M. M.; D'Agostino Dias, M.; Fontes, L. E.; Lunardi, M. C.; Youssef, N. C.; Lobo, S.; Silva, R.; Sales, J. A.; Melo, L. M. C.; Oliveira, M.; Fonte, M.; Grion, C.; Feijo, C.; Rezende, V.; Assuncao, M.; Neves, A. P.; Gusman, P.; Dalcomune, D.; Teixeira, C.; Kaefer, K.; Maia, I.;
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