Carrillo ER, Contreras DV

Language: Spanish
References: 21
Page: 5-9
PDF size: 65.42 Kb.

ABSTRACT

Introduction: Microalbuminuria is a marker of systemic disease and it is an early index of glomerular alteration in critically ill patients. Objective: To evaluate microalbuminuria as a predictor of outcome in patients with severe sepsis.
Design: Case series report.
Setting: ICU of a tertiary care hospital, Mexico City.
Patients: Twelve patients with severe sepsis (nine men and three women) admitted to a (ICU) during a six month period.
Interventions: Urine samples were obtained for micro-albuminuria determination by fast strip kit (CLINITEK Microalbumin^®) at 8, 24, 48, 72, 96 and 120 hours after admission. APACHE II and SOFA scores were calculated and correlated with microalbuminuria. The statistical analysis was made with univariated variance analysis for repeated variables. The difference among groups was analyzed by the t Student test.
Results: High levels of microalbuminuria were observed in the first determination in all the patients with a mean value of 106.66 ± 22.53 mg/L; the maximum values were at 48 hours (138.33 ± 16.47). Microalbuminuria descended to 79.16 ± 6.34 mg/L at 120 hours. The values of APACHE II and SOFA scores at admission were 23.66 ± 3.34 and 10.08 ± 0.92 points, respectively. APACHE score diminished to 4.1 ± 0.23 (p ‹ 0.05) points at 48 hours and to 10.9 ± 0.46 (p ‹ 0.003) points at 120 hours; SOFA score diminished 3.3 ± 0.26 (p ‹ 0.05) points in the first 48 hours y 2.75 ± 0.002 (p ‹ 0.004) points at 120 hours.
Conclusion: The measurement of microalbuminuria with fast strip kit technique is useful in the critically ill patients with sepsis and correlates with the severity of disease.

REFERENCES

1. Aird WC. Endothelium as an organ system. Crit Care Med 2004;32:S271-S279.

2. Hack CE, Zeerleder S. The endothelium in sepsis: Source of and target for inflammation. Crit Care Med 2001;29:S21-S27.

3. Moncada S, Higos A. The L-arginine-nitric oxide pathway. N Engl J Med 1993;329:2002-2012.

4. Knauss WA, Draper EA, Wagner DP et al. APACHE II a severity of disease classification system. Crit Care Med 1985;13:818.

5. Vincent JL, Moreno R, Takala I et al. The SOFA (sepsis- related organ failure assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996;22:707-710.

6. Maclsaac RJ, Jerums G, Cooper ME. New insights into the significance of microalbuminuria. Curr Opin Nephrol Hypertens 2004;13:83-91.

7. Gosling P. Microalbuminuria: a marker of systemic disease. Br J Hosp Med 1995;54:285-290.

8. De Gaudio AR, Adembri C, Grechi S et al. Microalbuminuria as an early index of impairment of glomerular permeability in postoperative septic patients. Intensive Care Med 2000;26:1364-1368.

9. Fleck A, Raines G, Hawker F et al. Increased vascular permeability: a major cause of albuminuria in disease and injury. Lancet 1985;i:781-783.

10. Thorevska N, Sabahi R, Upadya et al. Microalbuminuria in critically ill medical patients: Prevalence, predictors, and prognostic significance. Crit Care Med 2003;31: 1075-1081.

11. Gosling P, Shearman CP, Gwynn BR et al. Microproteinuria: response to operation. BMJ 1988;296:338-339.

12. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RHM, Sibbald WJ. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definition for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864-874.

13. Gosling P, Brudney S, McGrath L et al. Mortality prediction at admission to intensive care: a comparison of microalbuminuria with acute physiology scores after 24 hours. Crit Care Med 2003;31:98-103.

14. Gosling P, Sanghera K, Dickson G. Generalized vascular permeability and pulmonary function in patients following serious trauma. J Trauma 1994;36:477-481

15. Knight EL, Curhan GC. Editorial review: Albuminuria: moving beyond traditional microalbuminuria cut-points. Curr Opin Nephrol Hypertens 2003;12:283-284.

16. Stehouwer CD, Gall MA, Twist JW et al. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes 2002;51:1157-1165.

17. MacKinnon KL, Molnar Z, Lowe D. Use of microalbuminuria as a predictor of outcome in critically ill patients. Br J Anaesth 2000;S4:239-241.

18. Jones CA, Francis ME, Eberhardt MS et al. Microalbuminuria in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 2002;39(3): 445-59.

19. Romundstad S, Holmen J, Kvenild K et al. Microalbuminuria and all-cause mortality in 2,089 apparently health individuals: a 4.4-year follow-up study. The North Trendelag Health Study (HUNT), Norway. Am J Kidney Dis 2003;42: 466-473.

20. de Jong PE, Hillege HL, Pinto-Sietsma SJ et al. Screening for microalbuminuria in the general population: a tool to detect subjects at risk for progressive renal failure in an early phase? Nephrol Dial Transplant 2003;18:10-13.

21. Abid O, Qinghua S, Kenji S et al. Predictive Value of Microalbuminuria in Medical ICU Patients. Results of a Pilot Study. Chest 2001;120:1984-1988.