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The Importance of Microalbuminuria in Predicting Patient Outcome in a PICU

Anil, Ayse Berna MD1; Anil, Murat MD2; Yildiz, Meral MD3; Kamit Can, Fulya MD1; Bal, Alkan MD2; Gokalp, Gamze MD2; Aksu, Nejat MD4; Helvaci, Mehmet MD5

Pediatric Critical Care Medicine: June 2014 - Volume 15 - Issue 5 - p e220–e225
doi: 10.1097/PCC.0000000000000113
Online Clinical Investigations
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Objective: To evaluate the prognostic significance of microalbuminuria in critically ill children.

Design: Prospective study.

Setting: PICU of a teaching hospital.

Patients: Admitted critically ill children.

Interventions: The urine albumin-creatinine ratio was measured at admission and at 24 hours. Pediatric Risk of Mortality, Pediatric Index of Mortality II, Pediatric Logistic Organ Dysfunction, and Inotrope Score were calculated.

Measurements and Main Results: In total, 102 patients (median age, 19 mo) were included in the study, among whom were 30 mortalities. Microalbuminuria was identified in 62 patients (64%). The patients were classified into three groups: patients with sepsis, patients with noninfectious systemic inflammatory response syndrome, and patients without systemic inflammatory response syndrome. The highest clinical scores, albumin-creatinine ratio levels, mortality rate, and duration of mechanical ventilation were found in the sepsis group, and the lowest values were seen in patients without systemic inflammatory response syndrome (p < 0.05). Significant correlations were observed between the albumin-creatinine ratio levels and the clinical scores (p < 0.05). The receiver operating characteristics curve analysis showed that the areas under the curves were 0.818 and 0.781, respectively, for albumin-creatinine ratio measured at admission and at 24 hours to identify PICU mortality. At a cutoff value of 34.2 mg/g, albumin-creatinine ratio measured at admission may be able to discriminate between patients a with sensitivity of 63.3%, specificity of 93.3%, positive predictive value of 95%, and negative predictive value of 56%.

Conclusions: Microalbuminuria is a simple, inexpensive, and useful tool for predicting mortality and morbidity in critically ill children in the PICU.

1Pediatric Intensive Care Unit, Tepecik Training of Research Hospital, Izmir, Turkey.

2Pediatric Emergency Department, Tepecik Training of Research Hospital, Izmir, Turkey.

3Department of Pediatrics, Tepecik Training of Research Hospital, Izmir, Turkey.

4Pediatric Nephrology Unit, Tepecik Training of Research Hospital, Izmir, Turkey.

5Department of Pediatric Infection Disease, Tepecik Training of Research Hospital, Izmir, Turkey.

The authors have disclosed that they do not have any potential conflicts of interest.

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

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies