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. 2024 Oct 2;25(1):330.
doi: 10.1186/s12882-024-03760-2.

Creatinine clearance/eGFR ratio: a simple index for muscle mass related to mortality in ICU patients

Meint Volbeda  1 , Hendrik W Zijlstra  2 , Adrian Post  3 , Jenny E Kootstra-Ros  4 , Peter H J van der Voort  2 , Casper F M Franssen  3 , Maarten W Nijsten  2
Affiliations

Creatinine clearance/eGFR ratio: a simple index for muscle mass related to mortality in ICU patients

Meint Volbeda et al. BMC Nephrol. .

Abstract

Introduction: In patients admitted to the intensive care unit (ICU), muscle mass is inversely associated with mortality. Although muscle mass can be estimated with 24-h urinary creatinine excretion (UCE), its use for risk prediction in individual patients is limited because age-, sex-, weight- and length-specific reference values for UCE are lacking. The ratio between measured creatinine clearance (mCC) and estimated glomerular filtration rate (eGFR) might circumvent this constraint. The main goal was to assess the association of the mCC/eGFR ratio in ICU patients with all-cause hospital and long-term mortality.

Methods: The mCC/eGFR ratio was determined in patients admitted to our ICU between 2005 and 2021 with KDIGO acute kidney injury (AKI) stage 0-2 and an ICU stay ≥ 24 h. mCC was calculated from UCE and plasma creatinine and indexed to 1.73 m2. mCC/eGFR was analyzed by categorizing patients in mCC/eGFR quartiles and as continuous variable.

Results: Seven thousand five hundred nine patients (mean age 61 ± 15 years; 38% female) were included. In-hospital mortality was 27% in the lowest mCC/eGFR quartile compared to 11% in the highest quartile (P < 0.001). Five-year post-hospital discharge actuarial mortality was 37% in the lowest mCC/eGFR quartile compared to 19% in the highest quartile (P < 0.001). mCC/eGFR ratio as continuous variable was independently associated with in-hospital mortality in multivariable logistic regression (odds ratio: 0.578 (95% CI: 0.465-0.719); P < 0.001). mCC/eGFR ratio as continuous variable was also significantly associated with 5-year post-hospital discharge mortality in Cox regression (hazard ratio: 0.27 (95% CI: 0.22-0.32); P < 0.001).

Conclusions: The mCC/eGFR ratio is associated with both in-hospital and long-term mortality and may be an easily available index of muscle mass in ICU patients.

Keywords: Creatinine clearance; Critically ill patients; Estimated glomerular filtration rate; Mortality; Muscle mass; Sarcopenia; Urinary creatinine excretion.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Relation between mCC/eGFR ratio and UCE in males and females. Legend: Relation between mCC/eGFR ratios and UCE at day 1 of ICU admission in males (4677, with a Pearson’s r = 0.88; P < 0.001) and females (2832, r = 0.84; P < 0.001) separately to underscore the relation between mCC/eGFR and UCE and to demonstrate the difference in UCE range between males and females at an mCC/eGFR ratio of 1.1. The different slopes between males and females are a consequence of the higher UCE in males compared to females
Fig. 2
Fig. 2
Time course of mCC, eGFR, mCC/eGFR ratio and UCE. Legend: Graphical representation of (A) the course of eGFR and creatinine clearance during the ICU stay and (B) the course of the creatinine clearance to eGFR ratio (mCC/eGFR ratio) and urinary creatinine excretion (UCE) in patients (n = 303) with an ICU stay of at least 30 days. The lines are fitted using a locally estimated scatterplot smoothing (loess) function and the shaded area corresponds to the 95% confidence interval, calculated using a t-based approximation
Fig. 3
Fig. 3
Association between the mCC/eGFR ratio and in-hospital mortality and mortality 5 year after hospital discharge. Legend: Graphical representation of the association of mCC/eGFR ratio with the risk of (A) in-hospital and (B) 5 years post-hospital discharge mortality. The lines show the odds ratio (OR) for short-term mortality and hazard ratio (HR) for long-term mortality. The shaded area corresponds to the 95% pointwise confidence interval (CI). P-values are < 0.001 and < 0.001 for in-hospital mortality and long-term mortality, respectively. A histogram of the mCC/eGFR ratio is plotted in the background to demonstrate the distribution of the mCC/eGFR ratio. The graph demonstrates that a lower mCC/eGFR ratio is associated with higher risk of both in-hospital and long-term mortality
Fig. 4
Fig. 4
Kaplan–Meier curves over the first 30 days according to quartiles of mCC/eGFR ratio
Fig. 5
Fig. 5
Kaplan–Meier curves of 5 year post-hospital discharge mortality according to quartiles of mCC/eGFR ratio
See this image and copyright information in PMC

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