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Cadmium excretion predicting hospital mortality and illness severity of critically ill medical patients*

Lin, Ja-Liang MD; Lin-Tan, Dan-Tzu RN; Chu, Pao-Hsien MD; Chen, Yung-Chang MD; Huang, Yen-Lin MT; Ho, Tai-Chin MT; Lin, Chung-Yin MS

doi: 10.1097/CCM.0b013e318198675c
Clinical Investigations

Objective: To determine the prognostic value of day 1 urine excretion of cadmium (1st DUE-Cd) for predicting outcomes in intensive care unit (ICU) patients.

Design: Prospective study.

Setting: ICUs in Chang Gung Memorial Hospital, Lin-Kou Medical Center, Taiwan, ROC.

Patients: Two hundred one ICU patients.

Interventions: Urine and blood samples were taken within 24 hours after admission.

Measurements and Main Results: Disease severity, hospital mortality, and number of organ failures were evaluated in each medical ICU patient. Stepwise multiple linear regression analysis indicated that a history of chronic hepatitis, serum albumin, and glutamic-pyruvic transaminase were significantly related to 1st DUE-Cd after adjusting for other related variables. Cox multivariate analysis revealed that serum blood urea nitrogen level and ICU 1st DUE-Cd were significantly related to hospital mortality after other risk factors and scoring systems were adjusted. Each 1-μg increase in ICU 1st DUE-Cd was associated with a 7% increase in hospital mortality rate. All patients with poisoning magnitude of cadmium excretion (>10 μg/day) died, except one and those with normal cadmium excretion survived. Chi-square values of the Hosmer-Lemeshow goodness-of-fit test were 6.936 (p = 0.544), and area under the receiver operating characteristic curve was 0.868 (95% confidence intervals: 0.82–0.92) for ICU 1st DUE-Cd.

Conclusions: The ICU 1st DUE-Cd may predict hospital mortality in critically ill medical patients. Because of excess mortality and relatively small sample size, the predictive role of DUE-Cd needs further external validation.

From the Division of Nephrology and Clinical Toxicology (J-LL, D-TL-T, Y-CC, Y-LH, T-CH), Division of Cardiology (P-HC), Chang Gung Memorial Hospital, Lin-Kou Medical Center, Chang Gung University and School of Medicine; Institute of Biomedical Engineering (C-YL), National Taiwan University, Taipei, Taiwan, ROC.

Supported, in part, by Green Cross Health Service Association, Taipei, Taiwan, ROC.

The authors have not disclosed any potential conflicts of interest.

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© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins