Increased creatinine clearance in polytrauma patients with normal serum creatinine: a retrospective observational study

Abstract

IntroductionThe aim of this study, performed in an intensive care unit (ICU) population with a normal serum creatinine, was to estimate urinary creatinine clearance (CLCR) in a population of polytrauma patients (PT) through a comparison with a population of non trauma patients (NPT).MethodsThis was a retrospective, observational study in a medical and surgical ICU in a university hospital. A total of 284 patients were consecutively included. Two different groups were studied: PT (n = 144) and NPT (n = 140). Within the second week after admission to the ICU, renal function was assessed using serum creatinine, 24 h urinary CLCR .ResultsAmong the 106 patients with a CLCR above 120 mL minute-1 1.73 m-2, 79 were PT and 27 NPT (P < 0.0001). Only 63 patients had a CLCR below 60 mL minute-1 1.73 m-2 with 15 PT and 48 NPT (P < 0.0001). Patients with CLCR greater than 120 mL minute-1. 1.73 m -2 were younger, had a lower SAPS II score and a higher male ratio as compared to those having CLCR lower than 120 mL minute-1. 1.73 m -2. Through a logistic regression analysis, age and trauma were the only factors independently correlated to CLCR.ConclusionsIn ICU patients with normal serum creatinine, CLCR, is higher in PT than in NPT. The measure of CLCR should be proposed as routine for PT patients in order to adjust dose regimen, especially for drugs with renal elimination.

Augmented renal clearance in the critically ill: Prevalence, risk factors, and implications for beta-lactam therapy

“…A strong inverse relationship was also demonstrated between age and CL CR , as measured on the second post-operative day (84). Similar observations have been reported in more contemporary research (59,88,92,215), while the present study confirms these findings in a larger, multicentre dataset.…”

“…Multitrauma has already been identified as a significant risk factor for ARC (18,88,92) and this is further confirmed by our findings. The absence of any correlation between CI and CL CR in trauma is likely related to the higher CL CR measures observed in this group, the narrow range of recorded cardiac indices (see Figure 5.1) and the smaller sample size.…”

“…ARC is defined as the enhanced renal elimination of circulating solute (18). Specifically, elevated CL CR , has been reported in burns (44), TBI (92), polytrauma (88), sepsis (61), VAP (101), and general intensive care practice (59,84).…”

Optimising the administration of antibiotics in critically ill patients

“…Increased β-lactam clearance in patients with sepsis, but without organ dysfunction, can lead to subtherapeutic levels for significant periods. [14][15][16][17] CLcr should be routinely measured if there is doubt about the GFR and evidence that an 8-hour collection may be just as accurate as a 24-hour one. A recent prospective, singlecentre observational study of patients with VAP treated with doripenem or imipenem demonstrated a greater mortality and lower cure with CLcr >150 mL/min.…”

Covariate determinants of effective dosing regimens for time-dependent beta-lactam antibiotics for critically ill patients

“…The ARC incidence in critically ill patients is high and varies between 30% and 85% (ref. [5][6][7][8][9] ) depending on the population studied and the cut-off values used for its definition 8,10 . Extravascular volume expansion assessed as positive cumulative fluid balance (CFB) was reported in ICU patients undergoing aggressive fluid resuscitation for prevention against hypotension and prolonged vasopressor use 11,12 .…”