Urine output provides a rapid estimate for kidney function, and its use has been incorporated in the diagnosis of acute kidney injury. However, not many studies had validated its use compared to the plasma creatinine. It has been showed that the ideal urine output threshold for prediction of death or the need for dialysis was 0.3 ml/kg/h. We aim to assess this threshold in our local ICU population.
Introduction: The mNUTRIC score is a nutritional assessment tool to identify critically
ill patients with high nutritional risk who could benefit from nutritional interventions.
This study was conducted to validate the 28-day mortality prognostic performance
of the mNUTRIC score in a Malaysian intensive care unit (ICU). Methods: This was
a retrospective cohort study of adult patients who were consecutively admitted to
the ICU from January 2017 to December 2018 for >24 hours. Data were collected on
variables required to calculate the mNUTRIC score. Patients with mNUTRIC score
≥5 points were considered to be at high nutritional risk. Main outcome was 28-
day mortality from all causes; ICU length of stay (LOS) and prolonged mechanical
ventilation (MV) (>2 days) were secondary outcomes. Results: From a total of 432
admissions, 382 (88.4%) patients fulfilled the study criteria. Seventy-seven (20.2%)
of these patients were at high nutritional risk. They had longer mean ICU LOS
(7.1±7.5 days versus 4.2±4.0 days, p=0.001), greater proportion of prolonged MV
(57.1% versus 14.4%, p
Introduction: There has been increasing evidence of detrimental effects of cumulative positive fluid
balance in critically ill patients. The postulated mechanism of harm is the development of interstitial
oedema, with resultant increase morbidity and mortality. We aim to assess the impact of positive fluid
balance within the first 48 hours on mortality in our local ICU population. Methods: This was a secondary
analysis of a single centre, prospective observational study. All ICU patients more than 18 years were
screened for inclusion in the study. Admission of less than 48 hours, post-elective surgery and ICU
readmission were excluded. Cumulative fluid balance either as volume or percentage of body weight from
admission was calculated over 6, 24 and 48 hour period from ICU admission. Results: A total of 143 patients
were recruited, of these 33 died. There were higher cumulative fluid balances at 6, 24 and 48 hours in nonsurvivors
compared to survivors. However, after adjusted for severity of illness, APACHE II Score, they were
not predictive of mortality. Sensitivity analysis on sub-cohort of patients with acute kidney injury (AKI)
showed only an actual 48-hour cumulative fluid balance was independently predictive of mortality (1.21
(1.03 to 1.42)). Conclusions: Cumulative fluid balance was not independently predictive of mortality in a
heterogenous group of critically ill patients. However, in subcohort of patients with AKI, a 48-hour
cumulative fluid balance was independently predictive of mortality. An additional tile is thus added to the
mosaic of findings on the impact of fluid balance in a hetergenous group of critically ill patients, and in subcohort
of AKI patients.
Augmented renal clearance (ARC) is a phenomenon where there is elevated
renal clearance and defined by creatinine clearance more than 130ml/min. ARC results
in changes of the pharmacokinetic and pharmacodynamic of antimicrobial therapy being
administered, which may result in its subtherapeutic dose. We evaluated the
prevalence, risk factors and outcome of ARC in critically ill patients with sepsis. (Copied from article).
Currently, it is almost impossible to diagnose a patient at the onset of
sepsis due to the lack of real-time metrics with high sensitivity and specificity. The
purpose of the present study is to determine the diagnostic value of model-based insulin
sensitivity (SI) as a new sepsis biomarker in critically ill patients, and compare its
performance to classical inflammatory parameters. (Copied from article).
Clinical scoring methods such as the Sequential Organ Failure Assessment
(SOFA) score are frequently used to predict outcome in sepsis, with limited capacity.
Further tools for risk assessment of septic critically ill patients would thus be useful.
Our purpose was to derive a scoring method i.e. Sepsis Mortality Score using multimarker
approach for the prediction of 30-day mortality in septic critically ill patients,
and compare its performance to the SOFA score (Copied from article).
Plasma Cystatin C (CysC) is as an early functional marker for acute kidney
injury. Estimates of glomerular filtration rate using CysC (eGFRCysC) has been used in
some clinical setting. We evaluated the utility of CysC and eGFRCysC in diagnosing acute
kidney injury (AKI) and predicting death in critically ill patients with sepsis. (Copied from article).
Kinetic estimate of GFR (keGFR) is a more accurate estimate of GFR in the
acute settings with rapidly changing kidney functions. It takes into account the changes
of creatinine over time, creatinine production rate, and the volume of distribution,
however needs serial measurement of creatinine. We evaluated which methods of the
conventional eGFR measurement best correlates with keGFR. This could assist clinicians
in using a simpler method of calculation and is useful in the absence of serial plasma
creatinine. (Copied from article).