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. 2011 Oct;19(10):1527-32.
doi: 10.1007/s00520-010-0978-7. Epub 2010 Aug 15.

Small increases in serum creatinine are associated with prolonged ICU stay and increased hospital mortality in critically ill patients with cancer

Joshua Samuels  1 , Chaan S Ng, Joseph Nates, Kristen Price, Kevin Finkel, Abdulla Salahudeen, Andrew Shaw
Affiliations

Small increases in serum creatinine are associated with prolonged ICU stay and increased hospital mortality in critically ill patients with cancer

Joshua Samuels et al. Support Care Cancer. 2011 Oct.

Abstract

Purpose: Declining kidney function has been associated with adverse hospital outcome in cancer patients. ICU literature suggests that small changes in serum creatinine are associated with poor outcome. We hypothesized that reductions in renal function previously considered trivial would predict a poor outcome in critically ill patients with malignant disease. We evaluated the effects on hospital mortality and ICU length of stay of small changes in creatinine following admission to the intensive care unit.

Methods: We conducted a retrospective cohort study utilizing clinical, laboratory and pharmacy data collected from 3,795 patients admitted to the University of Texas M.D. Anderson Cancer Center's Intensive Care Unit. We conducted univariate and multivariate regression analysis to determine those factors associated with adverse ICU and hospital outcome.

Results: Increases in creatinine as small as 10% (0.2 mg/dl) were associated with prolonged ICU stay (5 days vs 6.6 days, p < 0.001) and increased mortality (14.6% vs 25.5%, p < 0.0001). Patients with a 25% rise in creatinine during the first 72 h of ICU admission were twice as likely to die in the hospital (14.3% vs 30.1%, p < 0.001). RIFLE criteria were accurate predictors of outcome, though they missed much of the risk of even smaller increases in creatinine.

Conclusions: Even small rises in serum creatinine following admission to the ICU are associated with increased morbidity and mortality in oncologic patients. The poor outcome in those with rising creatinine could not be explained by severity of illness or other risk factors. These small changes in creatinine may not be trivial, and should be regarded as evidence of a decline in an individual patient's condition.

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Conflict of interest statement

Conflict of Interest None of the authors has any significant conflict of interest to report.

Figures

Fig. 1
Fig. 1
Effect of rising creatinine on ICU length of stay
Fig. 2
Fig. 2
Effect of small rise in creatinine following ICU admission
Fig. 3
Fig. 3
Effects of small rise in creatinine on hospital mortality
Fig. 4
Fig. 4
Mortality by RIFLE criteria
Fig. 5
Fig. 5
Effects of small changes in creatinine on hospital mortality
See this image and copyright information in PMC

References

    1. Kierdorf H, Sieberth HG. Continuous treatment modalities in acute renal failure. Nephrol Dial Transplant. 1995;10(11):2001–2008. - PubMed
    1. Vandijck DM, Oeyen S, Decruyenaere JM, Annemans L, Hoste EA. Acute kidney injury, length of stay, and costs in patients hospitalized in the intensive care unit. Acta Clin Belg Suppl. 2007;2:341–345. - PubMed
    1. Cruz DN, Ronco C. Acute kidney injury in the intensive care unit: current trends in incidence and outcome. Crit Care. 2007;11(4):149. - PMC - PubMed
    1. Cantarovich F, Verho MT. A simple prognostic index for patients with acute renal failure requiring dialysis. French multicentric prospective study on furosemide in acute renal failure requiring dialysis. Ren Fail. 1996;18(4):585–592. - PubMed
    1. Ostermann M, Chang R. Correlation between the aki classification and outcome. Crit Care. 2008;12(6):R144. - PMC - PubMed

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