Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/CCM.0b013e3181fa431a
Clinical Investigations

Monitoring of plasma creatinine and urinary γ-glutamyl transpeptidase improves detection of acute kidney injury by more than 20%*

Blasco, Valéry MD; Wiramus, Sandrine MD; Textoris, Julien MD; Antonini, François MD; Bechis, Carole MD; Albanèse, Jacques MD, PhD; Martin, Claude MD, FCCM; Leone, Marc MD, PhD

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Objectives: We sought to determine how early we can detect acute kidney injury inpatients at intensive care unit admission by combining the use of plasma creatinine and urinary γ-glutamyl transpeptidase.

Design: Prospective study including development (n = 100) and validation (n = 56) cohorts.

Settings: Intensive care unit of a university hospital.

Interventions: None.

Measurements and Main Results: To determine acute kidney injury, we subtracted measured creatinine clearance from theoretical creatinine clearance with a 25% reduction signifying acute kidney injury. Its incidence in 100 consecutive patients was 36%. An indexed urinary γ-glutamyl transpeptidase–to–urinary creatinine ratio was significantly increased in the patients with acute kidney injury and did not correlate with plasma creatinine (p = .3). Using a predefined threshold of indexed urinary γ-glutamyl transpeptidase–to–urinary creatinine ratio (>12.4 units/mmol) and plasma creatinine (>89 μmol/L), acute kidney injury detection was significantly improved, making it possible to detect 22 (22%) additional patients with acute kidney injury. This finding was confirmed in the validation group. The rates of false-positive results were 30% and 19% in the data development and internal validation cohorts, respectively.

Conclusions: The use of low-cost, widely available markers (creatinine and urinary γ-glutamyl transpeptidase) increases the detection of acute kidney injury. Further studies are needed to determine the impact on outcome with the use of these biomarkers.

© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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