The importance of the urinary output criterion for the detection and prognostic meaning of AKI

Abstract Most reports on AKI claim to use KDIGO guidelines but fail to include the urinary output (UO) criterion in their definition of AKI. We postulated that ignoring UO alters the incidence of AKI, may delay diagnosis of AKI, and leads to underestimation of the association between AKI and ICU mor...

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Autores principales:	Jill Vanmassenhove, Johan Steen, Stijn Vansteelandt, Pawel Morzywolek, Eric Hoste, Johan Decruyenaere, Dominique Benoit, Wim Van Biesen
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ac20b3ddb47b4064a71b6eddb5599428
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spelling	oai:doaj.org-article:ac20b3ddb47b4064a71b6eddb55994282021-12-02T15:00:25ZThe importance of the urinary output criterion for the detection and prognostic meaning of AKI10.1038/s41598-021-90646-02045-2322https://doaj.org/article/ac20b3ddb47b4064a71b6eddb55994282021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90646-0https://doaj.org/toc/2045-2322Abstract Most reports on AKI claim to use KDIGO guidelines but fail to include the urinary output (UO) criterion in their definition of AKI. We postulated that ignoring UO alters the incidence of AKI, may delay diagnosis of AKI, and leads to underestimation of the association between AKI and ICU mortality. Using routinely collected data of adult patients admitted to an intensive care unit (ICU), we retrospectively classified patients according to whether and when they would be diagnosed with KDIGO AKI stage ≥ 2 based on baseline serum creatinine (Screa) and/or urinary output (UO) criterion. As outcomes, we assessed incidence of AKI and association with ICU mortality. In 13,403 ICU admissions (62.2% male, 60.8 ± 16.8 years, SOFA 7.0 ± 4.1), incidence of KDIGO AKI stage ≥ 2 was 13.2% when based only the SCrea criterion, 34.3% when based only the UO criterion, and 38.7% when based on both criteria. By ignoring the UO criterion, 66% of AKI cases were missed and 13% had a delayed diagnosis. The cause-specific hazard ratios of ICU mortality associated with KDIGO AKI stage ≥ 2 diagnosis based on only the SCrea criterion, only the UO criterion and based on both criteria were 2.11 (95% CI 1.85–2.42), 3.21 (2.79–3.69) and 2.85 (95% CI 2.43–3.34), respectively. Ignoring UO in the diagnosis of KDIGO AKI stage ≥ 2 decreases sensitivity, may lead to delayed diagnosis and results in underestimation of KDIGO AKI stage ≥ 2 associated mortality.Jill VanmassenhoveJohan SteenStijn VansteelandtPawel MorzywolekEric HosteJohan DecruyenaereDominique BenoitWim Van BiesenNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jill Vanmassenhove Johan Steen Stijn Vansteelandt Pawel Morzywolek Eric Hoste Johan Decruyenaere Dominique Benoit Wim Van Biesen The importance of the urinary output criterion for the detection and prognostic meaning of AKI
description	Abstract Most reports on AKI claim to use KDIGO guidelines but fail to include the urinary output (UO) criterion in their definition of AKI. We postulated that ignoring UO alters the incidence of AKI, may delay diagnosis of AKI, and leads to underestimation of the association between AKI and ICU mortality. Using routinely collected data of adult patients admitted to an intensive care unit (ICU), we retrospectively classified patients according to whether and when they would be diagnosed with KDIGO AKI stage ≥ 2 based on baseline serum creatinine (Screa) and/or urinary output (UO) criterion. As outcomes, we assessed incidence of AKI and association with ICU mortality. In 13,403 ICU admissions (62.2% male, 60.8 ± 16.8 years, SOFA 7.0 ± 4.1), incidence of KDIGO AKI stage ≥ 2 was 13.2% when based only the SCrea criterion, 34.3% when based only the UO criterion, and 38.7% when based on both criteria. By ignoring the UO criterion, 66% of AKI cases were missed and 13% had a delayed diagnosis. The cause-specific hazard ratios of ICU mortality associated with KDIGO AKI stage ≥ 2 diagnosis based on only the SCrea criterion, only the UO criterion and based on both criteria were 2.11 (95% CI 1.85–2.42), 3.21 (2.79–3.69) and 2.85 (95% CI 2.43–3.34), respectively. Ignoring UO in the diagnosis of KDIGO AKI stage ≥ 2 decreases sensitivity, may lead to delayed diagnosis and results in underestimation of KDIGO AKI stage ≥ 2 associated mortality.
format	article
author	Jill Vanmassenhove Johan Steen Stijn Vansteelandt Pawel Morzywolek Eric Hoste Johan Decruyenaere Dominique Benoit Wim Van Biesen
author_facet	Jill Vanmassenhove Johan Steen Stijn Vansteelandt Pawel Morzywolek Eric Hoste Johan Decruyenaere Dominique Benoit Wim Van Biesen
author_sort	Jill Vanmassenhove
title	The importance of the urinary output criterion for the detection and prognostic meaning of AKI
title_short	The importance of the urinary output criterion for the detection and prognostic meaning of AKI
title_full	The importance of the urinary output criterion for the detection and prognostic meaning of AKI
title_fullStr	The importance of the urinary output criterion for the detection and prognostic meaning of AKI
title_full_unstemmed	The importance of the urinary output criterion for the detection and prognostic meaning of AKI
title_sort	importance of the urinary output criterion for the detection and prognostic meaning of aki
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/ac20b3ddb47b4064a71b6eddb5599428
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The importance of the urinary output criterion for the detection and prognostic meaning of AKI

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