DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20221856
Published: 2022-07-25

Microalbuminuria as a predictor of patient outcome in pediatric intensive care unit

Syed Tariq, Marwah Mateen, Mohammad Ashraf, Safoora Wani, Javaid Ahmad Bhat

Abstract


Background: Critically ill children have disturbed milieu interior and these disturbances can be estimated by measuring how much apart one or many physiologic variables are from the normal range. In critical care units, predicting patients' outcomes is vital to the intensivist. It allows planning early aggressive therapeutic interventions, optimum resource allocation and appropriate family and patient counselling.

Methods: The study was conducted in the post graduate department of pediatrics and neonatology of tertiary care hospital. All patients admitted to our PICU for any critically ill ailment were classified into three groups.

Results: In our study of 250 patients, study groups were divided into three groups. Group 1 patients with sepsis; group 2 patients with SIRS and group 3 patients without sepsis and SIRS. Ninety-four patients belonged to group 1; 78 belonged to group 2 and 78 belonged to group 3. There were 42, 36 and 27 females in group 1, group 2 and group 3, respectively. Most patients resided in district Kupwara. Most cases had respiratory system involvement. The median albumin creatinine ratio within 6 hours of admission (ACR1) and at 24 hours was 148 mg/g and 97 mg/g, respectively, among survivors and 199.2 and 287 among non-survivors. There were 30 deaths in group 1, 11 deaths in group 2 and 5 deaths in group 3.

Conclusions: Microalbuminuria was found in 78.8% of critically ill children at admission. Urine albumin creatinine ratio at 6 and 24 hours of PICU stay was assessed to predict the degree of severity and mortality. It was found to have 88.5% sensitivity and 62.3% specificity.


Keywords


PICU, PRISM3, ACR

Full Text:

PDF

References


Ugra D, Chugh K, Khilnani P, Udani S. IAP Speciality Series on Pediatric Intensive Care; India: Jaypee Brothers; 2008.

Lacroix J, Cotting J. Pediatric acute lung injury and sepsis investigators (PALISI) network. severity of illness and organ dysfunction scoring in children. Pediatr Crit Care Med. 2005;6(3):S126-34.

Meyer EC, Snelling LK, Myren-Manbeck LK. Pediatric intensive care: the parents' experience. AACN Clin Issues. 1998;9(1):64-74.

Yeh TS, Pollack MM, Ruttimann UE, Holbrook PR, Fields AI. Validation of a physiologic stability index for use in critically ill infants and children. Pediatr Res. 1984;18(5):445-51.

Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988;16(11):1110-6.

Pollack MM, Patel KM, Ruttimann UE. Prism III: an updated Pediatric Risk of Mortality score. Crit Care Med. 1996;24(5):743-52.

Shann F, Pearson G, Slater A, Wilkinson K. Paediatric index of mortality (PIM): a mortality prediction model for children in intensive care. Intensive Care Med. 1997;23(2):201-7.

Slater A, Shann F, Pearson G. Paediatric index of mortality (PIM) study group. PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med. 2003;29(2):278-85.

Davies MG, Hagen PO. Systemic inflammatory response syndrome. Br J Surg. 1997;84(7):920-35.

Lezaic V. Albuminuria as a biomarker of the renal disease. In: Patel VB, ed. Biomarkers in kidney disease. Netherlands: Springer; 2015:1-18.

Bartz SK, Caldas MC, Tomsa A, Krishnamurthy R, Bacha F. Urine albumin-to-creatinine ratio: a marker of early endothelial dysfunction in youth. J Clin Endocrinol Metab. 2015;100(9):3393-9.

Nismath S, Rao SS, Baliga BS, Kulkarni V, Rao GM. Comparative validity of microalbuminuria versus clinical mortality scores to predict pediatric intensive care unit outcomes. Clin Exp Pediatr. 2020;63(1):20-4.

Gupta N, Sachdev A, Chugh P, Raheja K. Association of urinary albumin:creatinine ratio with outcome of children with sepsis. Indian J Crit Care Med. 2020; 24(6):465-72.

Basu S, Chaudhuri S, Bhattacharyya M, Chatterjee TK, Todi S, Majumdar A. Microalbuminuria: An inexpensive, non invasive bedside tool to predict outcome in critically ill patients. Indian J Clin Biochem. 2010;25(2):146-52.

Nismath S, Rao SS, Baliga BS, Kulkarni V, Rao GM. Comparison of urine albumin creatinine ratio with the pediatric index of mortality 2 score for prediction of pediatric intensive care unit outcomes. Ir J Med Sci. 2021;190(4):1481-5.

Anil AB, Anil M, Yildiz M. The importance of microalbuminuria in predicting patient outcome in a PICU. Pediatr Critic Care Med. 2014;15(5):e220-5.