Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically Ill Patients: A Secondary Analysis of a Multicenter Prospective Cohort Study

doi:10.4103/0366-6999.189059

Multicenter Study

. 2016 Sep 5;129(17):2050-7.

doi: 10.4103/0366-6999.189059.

Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically Ill Patients: A Secondary Analysis of a Multicenter Prospective Cohort Study

Jun-Ping Qin¹, Xiang-You Yu², Chuan-Yun Qian³, Shu-Sheng Li⁴, Tie-He Qin⁵, Er-Zhen Chen⁶, Jian-Dong Lin⁷, Yu-Hang Ai⁸, Da-Wei Wu⁹, De-Xin Liu¹⁰, Ren-Hua Sun¹¹, Zhen-Jie Hu¹², Xiang-Yuan Cao¹³, Fa-Chun Zhou¹⁴, Zhen-Yang He¹⁵, Li-Hua Zhou¹⁶, You-Zhong An¹⁷, Yan Kang¹⁸, Xiao-Chun Ma¹⁹, Ming-Yan Zhao²⁰, Li Jiang²¹, Yuan Xu²², Bin Du²³; China Critical Care Clinical Trial Group (CCCCTG)

Affiliations

¹ Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730; Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
² Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, China.
³ Department of Emergency Medicine and Medical Intensive Care Unit, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
⁴ Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
⁵ Department of Critical Care Medicine, Guangdong General Hospital, Guangzhou, Guangdong 510080, China.
⁶ Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China.
⁷ Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
⁸ Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
⁹ Department of Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China.
¹⁰ Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
¹¹ Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
¹² Department of Critical Care Medicine, Hebei Medical University Fourth Hospital, Shijiazhuang, Hebei 050011, China.
¹³ Department of Critical Care Medicine, Affiliated Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China.
¹⁴ Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China.
¹⁵ Department of Critical Care Medicine, Hainan Provincial People's Hospital, Haikou, Hainan 570311, China.
¹⁶ Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia 010050, China.
¹⁷ Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
¹⁸ Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
¹⁹ Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China.
²⁰ Department of Critical Care Medicine, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, China.
²¹ Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China.
²² Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
²³ Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730, China.

PMID: 27569230
PMCID: PMC5009587
DOI: 10.4103/0366-6999.189059

Multicenter Study

Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically Ill Patients: A Secondary Analysis of a Multicenter Prospective Cohort Study

Jun-Ping Qin et al. Chin Med J (Engl). 2016.

. 2016 Sep 5;129(17):2050-7.

doi: 10.4103/0366-6999.189059.

Authors

Affiliations

¹ Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730; Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
² Department of Critical Care Medicine, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang 830054, China.
³ Department of Emergency Medicine and Medical Intensive Care Unit, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
⁴ Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
⁵ Department of Critical Care Medicine, Guangdong General Hospital, Guangzhou, Guangdong 510080, China.
⁶ Department of Emergency Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai 200025, China.
⁷ Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
⁸ Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
⁹ Department of Critical Care Medicine, Qilu Hospital, Shandong University, Jinan, Shandong 250012, China.
¹⁰ Department of Emergency and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
¹¹ Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
¹² Department of Critical Care Medicine, Hebei Medical University Fourth Hospital, Shijiazhuang, Hebei 050011, China.
¹³ Department of Critical Care Medicine, Affiliated Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China.
¹⁴ Department of Emergency and Intensive Care Medicine, The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China.
¹⁵ Department of Critical Care Medicine, Hainan Provincial People's Hospital, Haikou, Hainan 570311, China.
¹⁶ Department of Critical Care Medicine, The Affiliated Hospital of Inner Mongolia Medical College, Hohhot, Inner Mongolia 010050, China.
¹⁷ Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
¹⁸ Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
¹⁹ Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning 110001, China.
²⁰ Department of Critical Care Medicine, The First Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150001, China.
²¹ Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China.
²² Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
²³ Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730, China.

PMID: 27569230
PMCID: PMC5009587
DOI: 10.4103/0366-6999.189059

Abstract

Background: Urine output (UO) is an essential criterion of the Kidney Disease Improving Global Outcomes (KDIGO) definition and classification system for acute kidney injury (AKI), of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria (KDIGOUO) could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria (KDIGOSCr).

Methods: We conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a 2-month prospective cohort study (July 1, 2009 to August 31, 2009) involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOUOand KDIGOSCr. Hospital mortality of patients with more severe AKI classification based on KDIGOUOwas compared with other patients by univariate and multivariate regression analyses.

Results: The prevalence of AKI increased from 52.4% based on KDIGOSCrto 55.4% based on KDIGOSCrcombined with KDIGOUO. KDIGOUOalso resulted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AKI classification based on KDIGOUO. Compared with non-AKI patients or those with maximum AKI classification by KDIGOSCr, those with maximum AKI classification by KDIGOUOhad a significantly higher hospital mortality of 58.4% (odds ratio [OR]: 7.580, 95% confidence interval [CI]: 4.141-13.873, P< 0.001). In a multivariate logistic regression analysis, AKI based on KDIGOUO (OR: 2.891, 95% CI: 1.964-4.254, P< 0.001), but not based on KDIGOSCr (OR: 1.322, 95% CI: 0.902-1.939, P = 0.152), was an independent risk factor for hospital mortality.

Conclusion: UO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

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Figures

**Figure 1**
Patient flow chart illustrating enrollment of the study population. ICU: Intensive Care Unit; LOS: Length of stay.

**Figure 2**
Kaplan-Meier survival curves from ICU admission to 90 days. Group A: KDIGO_SCr stage more severe than KDIGO_UO stage; Group B: KDIGO_SCr stage consistent with KDIGO_UO stage; Group C: KDIGO_SCr stage less severe than KDIGOUO stage. AKI: Acute kidney injury; ICU: Intensive Care Unit; KDIGO: Kidney Disease Improving Global Outcomes; KDIGO_SCr: KDIGO serum creatinine criteria; KDIGO_UO: KDIGO urine output criteria.

See this image and copyright information in PMC

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References

1. Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104:343–8. doi: 10.1016/S0002-9343(98)00058-8. - PubMed
1. de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–21. doi: 10.1007/s001340051281. - PubMed
1. Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–6. doi: 10.1053/ajkd.2002.32766. - PubMed
1. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA. 2005;294:813–8. doi: 10.1001/jama. 294.7.813. - PubMed
1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12. doi: 10.1186/cc2872. - PMC - PubMed

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[1] Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104:343–8. doi: 10.1016/S0002-9343(98)00058-8. - PubMed

[2] Chertow GM, Levy EM, Hammermeister KE, Grover F, Daley J. Independent association between acute renal failure and mortality following cardiac surgery. Am J Med. 1998;104:343–8. doi: 10.1016/S0002-9343(98)00058-8. - PubMed

[3] de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–21. doi: 10.1007/s001340051281. - PubMed

[4] de Mendonça A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: Risk factors and outcome evaluated by the SOFA score. Intensive Care Med. 2000;26:915–21. doi: 10.1007/s001340051281. - PubMed

[5] Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–6. doi: 10.1053/ajkd.2002.32766. - PubMed

[6] Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930–6. doi: 10.1053/ajkd.2002.32766. - PubMed

[7] Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA. 2005;294:813–8. doi: 10.1001/jama. 294.7.813. - PubMed

[8] Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: A multinational, multicenter study. JAMA. 2005;294:813–8. doi: 10.1001/jama. 294.7.813. - PubMed

[9] Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12. doi: 10.1186/cc2872. - PMC - PubMed

[10] Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – Definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12. doi: 10.1186/cc2872. - PMC - PubMed

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Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically Ill Patients: A Secondary Analysis of a Multicenter Prospective Cohort Study

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Value of Kidney Disease Improving Global Outcomes Urine Output Criteria in Critically Ill Patients: A Secondary Analysis of a Multicenter Prospective Cohort Study

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