Urinary creatinine excretion is related to short-term and long-term mortality in critically ill patients

Abstract

PurposePatients with reduced muscle mass have a worse outcome, but muscle mass is difficult to quantify in the ICU. Urinary creatinine excretion (UCE) reflects muscle mass, but has not been studied in critically ill patients. We evaluated the relation of baseline UCE with short-term and long-term mortality in patients admitted to our ICU.MethodsPatients who stayed ≥ 24 h in the ICU with UCE measured within 3 days of admission were included. We excluded patients who developed acute kidney injury stage 3 during the first week of ICU stay. As muscle mass is considerably higher in men than women, we used sex-stratified UCE quintiles. We assessed the relation of UCE with both in-hospital mortality and long-term mortality.ResultsFrom 37,283 patients, 6151 patients with 11,198 UCE measurements were included. Mean UCE was 54% higher in males compared to females. In-hospital mortality was 17%, while at 5-year follow-up, 1299 (25%) patients had died. After adjustment for age, sex, estimated glomerular filtration rate, body mass index, reason for admission and disease severity, patients in the lowest UCE quintile had an increased in-hospital mortality compared to the patients in the highest UCE quintile (OR 2.56, 95% CI 1.96–3.34). For long-term mortality, the highest risk was also observed for patients in the lowest UCE quintile (HR 2.32, 95% CI 1.89–2.85), independent of confounders.ConclusionsIn ICU patients without severe renal dysfunction, low urinary creatinine excretion is associated with short-term and long-term mortality, independent of age, sex, renal function and disease characteristics, underscoring the role of muscle mass as risk factor for mortality and UCE as relevant biomarker.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5359-6) contains supplementary material, which is available to authorized users.

The Change of Urea to Creatinine Ratio is Associated With Postoperative Complications and Skeletal Muscle Wasting in Pancreatic Cancer Patients Underwent Pancreatoduodenectomy

“…In addition, the alteration of serum creatinine was associated with the short-come mortality in AKI patients [34]. Since urinary creatinine is closely related serum creatinine and its production, it has been reported early low urinary creatinine excretion was a strong risk factor for both short-and long-term mortality in ICU patients without renal dysfunction [16].…”

“…Therefore, serum and urinary creatinine has been widely utilized to estimate muscle mass in stable outpatients [14,15]. Recently, the predictive value of creatinine on survival and muscle catabolism has been established in critical ill population [10,16]. But the role of creatinine on major abdominal surgery remains to be evaluated.…”

Complementary Biomarker Assessment of Components Absorbed from Diet and Creatinine Excretion Rate Reflecting Muscle Mass in Dialysis Patients

“…Interestingly, with the focus of nutrition in dialysis patients on protein energy malnutrition and preservation of muscle mass, it is relevant to note that assessment of creatinine excretion via 24 h urine collection is considered a reliable method for assessment of muscle mass in subjects not dependent on dialysis, and in previous studies in these subjects we have shown that low creatinine excretion is a very strong predictor of poor long-term outcome, with predictive strength increasing with increasing vulnerability of the population [17,18,19,20,21,22].…”

Plea for Reapplication of Some of the Older Nutrition Assessment Techniques

“…Given the impediments to making the standard measurement of creatinine height index a routine clinical nutrition assessment technique, it is possible to identify a higher‐risk group for the likelihood of severe PCM by estimating this index using only the serum creatinine level. Twenty‐four–hour urinary creatinine excretion continues to be a strong marker for risk of mortality in critically ill patients, 20 in renal‐transplant patients, 21 and in those with coronary artery disease 22 and type 2 diabetes, 23 all unadjusted for height, which would presumably make the risk even more specific had this been done. Interestingly, in 1 study of urinary creatinine excretion in a large cohort of patients with chronic kidney disease, mortality was associated with this parameter in end‐stage renal disease independent of fat‐free mass assessed by bioelectrical impedance measurement 24 .…”