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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
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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.

For information regarding this article, E-mail: jllin99@hotmail.com

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