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Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.
The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database / Vincent, J.-L., Ferguson, A., Pickkers, P., Jakob, S.M., Jaschinski, U., Almekhlafi, G.A., Leone, M., Mokhtari, M., Fontes, L.E., Bauer, P.R., Sakr, Y., Tomas, E., Bibonge, E.A., Charra, B., Faroudy, M., Doedens, L., Farina, Z., Adler, D., Balkema, C., Kok, A., et al.. - In: CRITICAL CARE. - ISSN 1364-8535. - 24:1(2020), pp. 171-185. [10.1186/s13054-020-02858-x]
The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database
Vincent J. -L.;Ferguson A.;Pickkers P.;Jakob S. M.;Jaschinski U.;Almekhlafi G. A.;Leone M.;Mokhtari M.;Fontes L. E.;Bauer P. R.;Sakr Y.;Tomas E.;Bibonge E. A.;Charra B.;Faroudy M.;Doedens L.;Farina Z.;Adler D.;Balkema C.;Kok A.;Alaya S.;Gharsallah H.;Muzha D.;Temelkov A.;Georgiev G.;Simeonov G.;Tsaryanski G.;Georgiev S.;Seliman A.;Vrankovic S.;Vucicevic Z.;Gornik I.;Barsic B.;Husedzinovic I.;Pavlik P.;Manak J.;Kieslichova E.;Turek R.;Fischer M.;Valkova R.;Dadak L.;Dostal P.;Malaska J.;Hajek R.;Zidkova A.;Lavicka P.;Starkopf J.;Kheladze Z.;Chkhaidze M.;Kaloiani V.;Medve L.;Sarkany A.;Kremer I.;Marjanek Z.;Tamasi P.;Krupnova I.;Vanags I.;Liguts V.;Pilvinis V.;Vosylius S.;Kekstas G.;Balciunas M.;Kolbusz J.;Kubler A.;Mielczarek B.;Mikaszewska-Sokolewicz M.;Kotfis K.;Tamowicz B.;Sulkowski W.;Smuszkiewicz P.;Pihowicz A.;Trejnowska E.;Hagau N.;Filipescu D.;Droc G.;Lupu M. N.;Nica A.;Stoica R.;Tomescu D. R.;Constantinescu D. L.;Valcoreanu Zbaganu G. M.;Slavcovici A.;Bagin V.;Belsky D.;Palyutin S.;Shlyapnikov S.;Bikkulova D.;Gritsan A.;Natalia G.;Makarenko E.;Kokhno V.;Tolkach A.;Kokarev E.;Belotserkovskiy B.;Zolotukhin K.;Kulabukhov V.;Soskic L.;Palibrk I.;Jankovic R.;Jovanovic B.;Pandurovic M.;Bumbasirevic V.;Uljarevic B.;Surbatovic M.;Ladjevic N.;Slobodianiuk G.;Sobona V.;Cikova A.;Gebhardtova A.;Jun C.;Yunbo S.;Dong J.;Feng S.;Duan M.;Xu Y.;Xue X.;Gao T.;Xing X. Z.;Zhao X.;Li C. H.;Gengxihua G.;Tan H.;Xu J.;Jiang L.;Tiehe Q.;Bingyu Q.;Shi Q.;Lv Z.;Zhang L.;Jingtao L.;Zhen Z.;Wang Z.;Wang T. H.;Yuhong L.;Zhai Q.;Chen Y.;Wang C.;Jiang W.;Ruilan W.;Chen Y.;Xiaobo H.;Ge H.;Yan T.;Yuhui C.;Zhang J.;Jian-Hong F.;Zhu H.;Huo F.;Wang Y.;Li C.;Zhuang M.;Ma Z.;Sun J.;Liuqingyue L.;Yang M.;Meng J.;Ma S.;Kang Y.;Yu L.;Peng Q.;Wei Y.;Zhang W.;Sun R.;Yeung A.;Wan W. L.;Sin K. K. C.;Lee K. L.;Wijanti M.;Widodo U.;Samsirun H.;Sugiman T.;Wisudarti C.;Maskoen T. T.;Hata N.;Kobe Y.;Nishida O.;Miyazaki D.;Nunomiya S.;Uchino S.;Kitamura N.;Yamashita K.;Hashimoto S.;Fukushima H.;Adib N. A. N.;Tai L. L.;Tony B.;Bigornia R. R.;Bigornia R. R.;Palo J. E.;Chatterjee S.;Tan B. H.;Kong A.;Goh S.;Lee C. -C.;Pothirat C.;Khwannimit B.;Theerawit P.;Pornsuriyasak P.;Piriyapatsom A.;Mukhtar A.;Hamdy A. N.;Hosny H.;Ashraf A.;Mokhtari M.;Nowruzinia S.;Lotfi A. H.;Zand F.;Nikandish R.;Moghaddam O. M.;Cohen J.;Sold O.;Sfeir T.;Hasan A. Y.;Abugaber D.;Ahmad H.;Tantawy T.;Baharoom S.;Algethamy H.;Amr A.;Almekhlafi G.;Coskun R.;Sungur M.;Cosar A.;Gucyetmez B.;Demirkiran O.;Senturk E.;Ulusoy H.;Atalan H. K.;Serin S.;Kati I.;Alnassrawi Z.;Almemari A.;Krishnareddy K.;Kashef S.;Alsabbah A.;Poirier G.;Marshall J. C.;Herridge M.;Fernandez-Medero R.;Fulda G.;Banschbach S.;Quintero J.;Schroeder E.;Sicoutris C.;Gueret R.;Kashyap R.;Bauer P.;Nanchal R.;Wunderink R. G.;Jimenez E.;Ryan A.;Prince D.;Edington J.;Van Haren F.;Bersten A.;Hawkins D. J.;Kilminster M.;Sturgess D.;Ziegenfuss M.;O' Connor S.;Lipman J.;Campbell L.;McAllister R.;Roberts B.;Williams P.;Parke R.;Seigne P.;Freebairn R.;Nistor D.;Oxley C.;Young P.;Valentini R.;Wainsztein N.;Comignani P.;Casaretto M.;Sutton G.;Villegas P.;Galletti C.;Neira J.;Rovira D.;Hidalgo J.;Sandi F.;Caser E.;Thompson M. M.;D'Agostino Dias M.;Fontes L. E.;Lunardi M. C.;Youssef N. C.;Lobo S.;Silva R.;Sales J. A.;Melo L. M. C.;Oliveira M.;Fonte M.;Grion C.;Feijo C.;Rezende V.;Assuncao M.;Neves A. P.;Gusman P.;Dalcomune D.;Teixeira C.;Kaefer K.;Maia I.;Dantas V. S.;Filho R. C.;Amorim F.;Assef M.;Schiavetto P.;Houly J.;Bianchi F.;Dias F.;Avila C.;Rego L.;Castro P.;Passos J.;Mendes C.;Grion C.;Mecatti G. C.;Ferrreira M.;Irineu V.;Guerreiro M.;Ugarte S.;Tomicic V.;Godoy C.;Samaniego W.;Escamilla I.;Castro Castro L. F.;Duque G. L.;Diaz-Guio D.;Benitez F.;Urrego A. G.;Buitrago R.;Ortiz G.;Villalba Gaviria M. C.;Salas D.;Ramirez-Arce J.;Salgado E.;Morocho D.;Vergara J.;Sang M. C.;Orellana-Jimenez C.;Garrido L.;Diaz O.;Resiere D.;Osorio C.;De La Vega A.;Carrillo R.;Sanchez V.;Villagomez A.;Zubieta R. M.;Sandia M.;Zalatiel M.;Poblano M.;Gonzalez D. R.;Arrazola F.;Juan Francisco L. L.;Namendys-Silva S. A.;Moya R. G.;Hernandez M.;Rodriguez Cadena D. M.;Islas I. L.;Ballesteros Zarzavilla C. M.;Matos A.;Oyanguren I.;Cerna J.;Sierra R. Q.;Jimenez R.;Castillo L.;Ocal R.;Sencan A.;Mareque Gianoni S. M.;Deicas A.;Hurtado J.;Burghi G.;Martinelli A.;Von Der Osten I.;Du Maine C.;Bhattacharyya M.;Bandyopadhyay S.;Yanamala S.;Gopal P.;Sahu S.;Ibrahim M.;Rathod D.;Mukundan N.;Dewan A.;Amin P.;Samavedam S.;Shah B.;Gurupal G.;Lahkar B.;Mandal A. K.;Sircar M.;Ghosh S.;Balasubramani V.;Kapadia F.;Vadi S.;Nair K.;Tripathy S.;Nandakumar S.;Sharma J.;Kar A.;Jha S.;Zirpe K.;Patel M.;Bhavsar A.;Samaddar D. P.;Kulkarni A.;Hashmi M.;Ali W.;Nadeem S.;Indraratna K.;Margarit A.;Urbanek P.;Schlieber J.;Reisinger J.;Auer J.;Hartjes A.;Lerche A.;Janous T.;Kink E.;Krahulec W.;Smolle K. -H.;Van Der Schueren M.;Thibo P.;Vanhoof M.;Ahmet I.;Gadisseux P.;Dufaye P.;Jacobs O.;Fraipont V.;Biston P.;Dive A.;Bouckaert Y.;Gilbert E.;Gressens B.;Pinck E.;Collin V.;Vincent J. -L.;De Waele J. J.;Rimachi R.;Gusu D.;De Decker K.;Mandianga K.;Heytens L.;Wittebole X.;Spapen H.;Van Collie O.;Vandenheede W.;Rogiers P.;Kolodzeike P.;Kruse M.;Andersen T.;Harjola V. -P.;Saarinen K.;Leone M.;Durocher A.;Moulront S.;Lepape A.;Losser M. -R.;Cabaret P.;Kalaitzis E.;Zogheib E.;Charve P.;Francois B.;Lefrant J. -Y.;Beilouny B.;Forceville X.;Misset B.;Jacobs F.;Floccard B.;Payen D.;Wynckel A.;Castelain V.;Faure A.;Lavagne P.;Lepoivre T.;Moussa M. D.;Vieillard-Baron A.;Durand M.;Gainnier M.;Ichai C.;Arens S.;Hoffmann C.;Kaffarnik M.;Scharnofske C. -J.;Voigt I.;Peckelsen C.;Weber M.;Gille J.;Lange A.;Schoser G.;Sablotzki A.;Jaschinski U.;Bluethgen A.;Vogel F.;Tscheu A.;Fuchs T.;Wattenberg M.;Helmes T.;Scieszka S.;Heintz M.;Sakka S.;Kohler J.;Fiedler F.;Danz M.;Sakr Y.;Riessen R.;Kerz T.;Kersten A.;Tacke F.;Marx G.;Volkert T.;Schmutz A.;Nierhaus A.;Kluge S.;Abel P.;Janosi R. A.;Utzolino S.;Bracht H.;Toussaint S.;Peftoulidou M. G.;Myrianthefs P.;Armaganidis A.;Routsi C.;Xini A.;Mouloudi E.;Kokoris I.;Kyriazopoulos G.;Vlachos S.;Lavrentieva A.;Partala P.;Nakos G.;Moller A.;Stefansson S. O.;Barry J.;O'Leary R. A.;Motherway C.;Faheem M.;Dunne E.;Donnelly M.;Konrad T.;Bonora E.;Achilli C.;Rossi S.;Castiglione G.;Peris A.;Albanese D.;Stocchetti N.;Citerio G.;Mozzoni L.;Sisillo E.;De Negri P.;Savioli M.;Vecchiarelli P.;Puflea F.;Stankovic V.;Minoja G.;Montibeller S.;Calligaro P.;Sorrentino R.;Feri M.;Zambon M.;Colombaroli E.;Giarratano A.;Pellis T.;Capra C.;Antonelli M.;Gullo A.;Chelazzi C.;De Capraris A.;Patroniti N.;Girardis M.;Franchi F.;Berlot G.;Buttigieg M.;Ponssen H.;Ten Cate J.;Bormans L.;Husada S.;Buise M.;Van Der Hoven B.;Reidinga A.;Kuiper M.;Pickkers P.;Kluge G.;Den Boer S.;Kesecioglu J.;Van Leeuwen H.;Flaatten H.;Mo S.;Branco V.;Rua F.;Lafuente E.;Sousa M.;Catorze N.;Barros M.;Pereira L.;De Oliveira A. V.;Gomes J.;Gaspar I.;Pereira M. F.;Cymbron M.;Dias A.;Almeida E.;Beirao S.;Serra I.;Ribeiro R.;Povoa P.;Faria F.;Costa-E-Silva Z.;Nobrega J. J.;Fernandes F.;Gabriel J.;Voga G.;Rupnik E.;Kosec L.;Povsic M. K.;Osojnik I.;Tomic V.;Sinkovic A.;Gonzalez J.;Zavala E.;Valenzuela J. P.;Marina L.;Vidal-Cortes P.;Posada P.;Martin-Loeches I.;Guillen N. M.;Palomar M.;Sole-Violan J.;Torres A.;Gonzalez Gallego M. A.;Aguilar G.;Allue R. M.;Argueso M.;Parejo M.;Navarro M. P.;Jose A.;Nin N.;Lerma F. A.;Martinez O.;Lozano E. T.;Lopez S. A.;Perez Granda M. J.;Moreno S.;Llubia C.;Martos C. D. L. F.;Gonzalez-Arenas P.;Fernandez N. L.;Rueda B. G.;Pons I. E.;Cruza N.;Maroto F.;Estella A.;Ferrer A.;Fraile L. I.;Quindos B.;Quintano A.;Tebar M. T.;Cardinal P.;Reyes A.;Rodriguez A.;Abella A.;Del Valle S. G.;Yus S.;Maseda E.;Berezo J. A.;Pedregosa A. T.;Laplaza C.;Ferrer R.;Rico-Feijoo J.;Rodriguez M.;Monedero P.;Eriksson K.;Lind D.;Chabanel D.;Zender H.;Heer K.;Frankenberger B.;Jakob S.;Haller A.;Matthew S.;Downes R.;Groba C. B.;Johnston A.;Meacher R.;Keays R.;Haji-Michael P.;Tyler C.;Ferguson A.;Jones S.;Tyl D.;Ball A.;Vogel J.;Booth M.;Downie P.;Watters M.;Brett S.;Garfield M.;Everett L.;Heenen S.;Dhir S.;Beardow Z.;Mostert M.;Brosnan S.;Pinto N.;Harris S.;Summors A.;Norton A.;Rose A.;Appelboam R.;Davies O.;Vickers E.;Agarwal B.;Szakmany T.;Wimbush S.;Welters I.;Pearse R.;Hollands R.;Kirk-Bayley J.;Fletcher N.;Bray B.;Brealey D.;Alexander P.;Henderson S.;Hargreaves C.;Black H.;Gowda K.
2020
Abstract
Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.
The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database / Vincent, J.-L., Ferguson, A., Pickkers, P., Jakob, S.M., Jaschinski, U., Almekhlafi, G.A., Leone, M., Mokhtari, M., Fontes, L.E., Bauer, P.R., Sakr, Y., Tomas, E., Bibonge, E.A., Charra, B., Faroudy, M., Doedens, L., Farina, Z., Adler, D., Balkema, C., Kok, A., et al.. - In: CRITICAL CARE. - ISSN 1364-8535. - 24:1(2020), pp. 171-185. [10.1186/s13054-020-02858-x]
Vincent, J. -L.; Ferguson, A.; Pickkers, P.; Jakob, S. M.; Jaschinski, U.; Almekhlafi, G. A.; Leone, M.; Mokhtari, M.; Fontes, L. E.; Bauer, P. R.; Sa...espandi
Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1208787
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