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1. Association of oliguria with the development of acute kidney injury in the critically ill

Author

Suvi T. Vaara, Ilkka Parviainen, Ville Pettilä, Sara Nisula, Outi Inkinen, Ari Uusaro, Raili Laru-Sompa, Anni Pulkkinen, Minna Saarelainen, Mikko Reilama, Sinikka Tolmunen, Ulla Rantalainen, Markku Suvela, Katrine Pesola, Pekka Saastamoinen, Kirsi-Maija Kaukonen, Anna-Maija Korhonen, Suvi Vaara, Raili Suojaranta-Ylinen, Leena Mildh, Mikko Haapio, Laura Nurminen, Sari Sutinen, Leena Pettilä, Helinä Laitinen, Heidi Syrjä, Kirsi Henttonen, Elina Lappi, Tero Varpula, Päivi Porkka, Mirka Sivula, Mira Rahkonen, Anne Tsurkka, Taina Nieminen, Ari Alaspää, Ville Salanto, Hanna Juntunen, Esko Ruokonen, Stepani Bendel, Niina Rissanen, Maarit Lång, Sari Rahikainen, Saija Rissanen, Merja Ahonen, Elina Halonen, Meri Poukkanen, Esa Lintula, Jorma Heikkinen, Timo Lavander, Kirsi Heinonen, Tadeusz Kaminski, Fiia Gäddnäs, Tuija Kuusela, Sari Karlsson, Matti Reinikainen, Tero Surakka, Helena Jyrkönen, Tanja Eiserbeck, Tero Ala-Kokko, Jouko Laurila, Vesa Lund, Päivi Tuominen, Pauliina Perkola, Riikka Tuominen, Marika Hietaranta, Seppo Hovilehto, Anne Kirsi, Pekka Tiainen, Tuija Myllärinen, Pirjo Leino, Anne Kuitunen, Jyrki Tenhu-nen, Ilona Leppänen, Markus Levoranta, Sanna Hoppu, Jukka Sauranen, Atte Kukkurainen, Samuli Kortelainen, Niina Koivuviita, Jutta Kotamäki, Simo-Pekka Koivisto, Raku Hautamäki, and Maria Skinnar

Subjects
Pathology, medicine.medical_specialty, medicine.medical_treatment, 030232 urology & nephrology, Urine, urologic and male genital diseases, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Oliguria, Intensive care, Severity of illness, medicine, Renal replacement therapy, Prospective cohort study, ta3126, Creatinine, business.industry, Acute kidney injury, 030208 emergency & critical care medicine, medicine.disease, female genital diseases and pregnancy complications, chemistry, Nephrology, Anesthesia, medicine.symptom, business
Abstract

Urine output (UO) criterion may increase the sensitivity of the definition of acute kidney injury (AKI). We determined whether the empirically derived definition for oliguria (0.5 ml/kg/h) is independently associated with adverse outcome. Data analysis included hourly recorded UO from the prospective, multicenter FINNAKI study conducted in 16 Finnish intensive care units. Confounder-adjusted association of oliguria of different severity and duration primarily with the development of AKI defined by creatinine criterion (Cr-AKI) or renal replacement therapy (RRT) was assessed. Secondarily, we determined the association of oliguria with 90-day mortality. Of the 1966 patients analyzed for the development of AKI, 454 (23.1%) reached this endpoint. Within this AKI cohort, 312 (68.7%) developed Cr-AKI, 21 (4.6%) commenced RRT without Cr-AKI, and 121 (26.7%) commenced RRT with Cr-AKI. Episodes of severe oliguria (0.1 ml/kg/h) for more than 3 h were independently associated with the development of Cr-AKI or RRT. The shortest periods of consecutive oliguria independently associated with an increased risk for 90-day mortality were 6-12 h of oliguria from 0.3 to0.5 ml/kg/h, over 6 h of oliguria from 0.1 to0.3 ml/kg/h, and severe oliguria lasting over 3 h. Thus, our findings underlie the importance of hourly UO measurements.Kidney International advance online publication, 9 September 2015; doi:10.1038/ki.2015.269.

Published
2016
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2. Predictive value of urine interleukin-18 in the evolution and outcome of acute kidney injury in critically ill adult patients

Author

Pekka Tiainen, Tuija Kuusela, Samuli Kortelainen, Simo-Pekka Koivisto, A.M. Korhonen, Helinä Laitinen, M. Haapio, Stepani Bendel, Tanja Eiserbeck, Jorma Heikkinen, Anne Tsurkka, Mikko Reilama, Anne Kuitunen, S.T. Vaara, Jaana Kallinen, Ari Alaspää, Suvi T. Vaara, Sirpa Suominen, Katrine Pesola, Laura Nurminen, Esa Lintula, Anne Toropainen, Meri Poukkanen, Timo Lavander, Elina Halonen, Raili Suojaranta-Ylinen, Jyrki Tenhunen, Simo Varila, Fiia Gäddnäs, Jukka Sauranen, Niina Prittinen, Esko Ruokonen, Pauliina Perkola, Markus Levoranta, Jane Roiko, Anne-Mari Juopperi, Outi Inkinen, K.M. Kaukonen, Hillevi Boman, Riikka Tuominen, Markku Suvela, J. Tenhunen, Tero Ala-Kokko, Sara Nisula, Tero Varpula, Tadeusz Kaminski, Jouko Laurila, Hanna Juntunen, Tuija Myllärinen, Kirsi Heinonen, Pekka Saastamoinen, Ilkka Parviainen, Kirsi-Maija Kaukonen, Leena Mildh, Ilona Leppänen, Sari Sutinen, Ville Pettilä, Satu Johansson, Jutta Kotamäki, V. Pettilä, S. Nisula, Seppo Hovilehto, Päivi Tuominen, Anna-Maija Korhonen, Mirka Sivula Mira Rahkonen, Sanna Hoppu, Anu Laine, Maria Skinnar, Maarit Lång, Anne Kirsi, Niina Koivuviita, Ville Salanto, Taina Nieminen, Minna Saarelainen, Pirjo Leino, Sari Rahikainen, Teija Sanisalo, Minna Tallgren, Merja Ahonen, Heidi Syrjä, Raili Laru-Sompa, Sinikka Tolmunen, Saija Rissanen, Ulla Rantalainen, Marja Miettinen, Atte Kukkurainen, Anni Pulkkinen, Ari Uusaro, R. Yang, Niina Rissanen, Raku Hautamäki, Vesa Lund, Päivi Porkka, Sirpa Kauppinen, Elina Lappi, Sari Karlsson, Leena Pettilä, M. Poukkanen, Marika Hietaranta, Tero Surakka, Kirsi Henttonen, Sinikka Sälkiö, Eija Vaskelainen, Matti Reinikainen, Mikko Haapio, and Helena Jyrkönen

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Critical Illness, urologic and male genital diseases, law.invention, law, Predictive Value of Tests, Intensive care, Internal medicine, medicine, Humans, Renal replacement therapy, Prospective Studies, Intensive care medicine, Acute tubular necrosis, Aged, ta3126, Receiver operating characteristic, business.industry, Acute kidney injury, Interleukin-18, Acute Kidney Injury, Middle Aged, medicine.disease, Intensive care unit, Confidence interval, Patient Outcome Assessment, Renal Replacement Therapy, Intensive Care Units, Anesthesiology and Pain Medicine, ROC Curve, Area Under Curve, Biomarker (medicine), Female, business, Biomarkers, Follow-Up Studies
Abstract

Background Interleukin-18 (IL-18) is a pro-inflammatory protein, which mediates ischaemic tubular injury, and has been suggested to be a sensitive and specific biomarker for acute kidney injury (AKI). The predictive value of IL-18 in the diagnosis, evolution, and outcome of AKI in critically ill patients is still unclear. Methods We measured urine IL-18 from critically ill patients at intensive care unit (ICU) admission and 24 h. We evaluated the association of IL-18 with developing new AKI, renal replacement therapy (RRT), and 90-day mortality. We calculated areas under receiver operating characteristics curves (AUCs), best cut-off values, and positive likelihood ratios (LR+) for IL-18 concerning these endpoints. Additionally, we compared the predictive value of IL-18 at ICU admission to that of urine neutrophil gelatinase-associated lipocalin (NGAL). Results In this study population of 1439 patients the highest urine IL-18 during the first 24 h in the ICU associated with the development of AKI with an AUC [95% confidence interval (CI)] of 0.586 (0.546–0.627) and with the development of Stage 3 AKI with an AUC (95% CI) of 0.667 (0.591–0.774). IL-18 predicted the initiation of RRT with an AUC (95% CI) of 0.655 (0.572–0.739), and 90-day mortality with an AUC (95% CI) of 0.536 (0.497–0.574). Conclusions IL-18 had poor-to-moderate ability to predict AKI, RRT, or 90-day mortality in this large cohort of critically ill patients. Thus, it should be used with caution for diagnostic or predictive purposes in the critically ill.

Published
2014

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