Prognostic Value of Urinary Albumin Creatinine Ratio in Septic Patients and Its Role in Early Detection of Acute Kidney Injury
Authors: labib Heba Abdel Azim , Salama Hala Gomaa , hakim Mahmoud Ahmed Abdel , Eltouny Khaled Ahmed Ramadan 
Published: August 2023

Abstract

Background
Sepsis remains a major global healthcare concern, owing to high morbidity and mortality, despite the advances in medical therapeutics. Targeted therapies probably lose their efficacy due to late administration. Early administration of intensive therapy to critically ill patients has shown promise in improving mortality. An early event is the loss of barrier integrity leading to systemic capillary leak which is manifested as increased excretion of albumin in the urine. Microalbuminuria, defined as 30–300 mg/day of albumin excretion in the urine is a common finding in critically ill patients, where it has shown promise not only as a predictor of organ failure and vasopressor requirement but of mortality, faring better than SOFA and APACHE II score.

Objective
Investigate the dynamic changes in urine albumin /creatinine ratio in patients with sepsis in the intensive care setting, its prognostic value and its role in early detection of acute kidney injury regarding the clinical coarse and final outcome. Moreover, to compare this prognostic value with APACHI II and SOFA scoring systems.

Patients and Methods
This study was conducted in critical care department to evaluate the degree of microalbuminuria (ACR) in sepsis patients and whether it could predict mortality in critically ill sepsis patients and early detection of acute kidney injury, also to evaluate the relationship between microalbuminuria and SOFA &APACHE II score. Patients presenting with features of sepsis and suspected infection were included in the study and after exclusion, a total of 40 patients were included in the study. Urine sample for ACR (Albumin and Creatinine Ratio) was done at ICU admission (ACR1) and at 24 hours (ACR2) of admission and APACHI II &SOFA calculated.

Results
Receiver operator characteristic (ROC) curve was calculated for the use of ACR concentration as a predictor of ICU mortality.the best cutoff point of ACR to predict mortality was (147.2) with (81.8%) sensitivity, (82.8%) specificity, (64.3%) PPV and (92.3%) NPV and (82.5%) accuracy. the best cutoff point of SOFA score to predict mortality was (3.5) with (90.9%) sensitivity, (72.4%) specificity, (55.6%) PPV and (95.5%) NPV and (77.5%) accuracy. the best cutoff point of APACHE II to predict mortality was (22.5) with (81.8%) sensitivity, (86.2%) specificity, (69.2%) PPV and (92.6%) NPV and (85%) accuracy.

Conclusion
This study have shown that the urinary Albumin/Creatinin ratio(ACR) concentrations were elevated early in patients who were admitted to the ICU with sepsis criteria, the urinary Albumin/Creatinin ratio(ACR) concentrations were also significantly higher in patients who needed the organ supportive measures (mechanical ventilation, inotropic /vasopressor support and haemodialysis) during their ICU stay. The urinary Albumin/Creatinin ratio (ACR) concentrations were also significantly higher in ICU non-survivors than those who survived and when used as a predictor of ICU mortality, the best cutoff point of ACR to predict mortality was (147.2) with (81.8%) sensitivity, (82.8%) specificity, (64.3%) PPV and (92.3%) NPV and (82.5%) accuracy.