Intensive Care Medicine

, Volume 39, Issue 3, pp 414–419 | Cite as

Empirical relationships among oliguria, creatinine, mortality, and renal replacement therapy in the critically ill

  • Tal Mandelbaum
  • Joon Lee
  • Daniel J. Scott
  • Roger G. Mark
  • Atul Malhotra
  • Michael D. Howell
  • Daniel TalmorEmail author



The observation periods and thresholds of serum creatinine and urine output defined in the Acute Kidney Injury Network (AKIN) criteria were not empirically derived. By continuously varying creatinine/urine output thresholds as well as the observation period, we sought to investigate the empirical relationships among creatinine, oliguria, in-hospital mortality, and receipt of renal replacement therapy (RRT).


Using a high-resolution database (Multiparameter Intelligent Monitoring in Intensive Care II), we extracted data from 17,227 critically ill patients with an in-hospital mortality rate of 10.9 %. The 14,526 patients had urine output measurements. Various combinations of creatinine/urine output thresholds and observation periods were investigated by building multivariate logistic regression models for in-hospital mortality and RRT predictions. For creatinine, both absolute and percentage increases were analyzed. To visualize the dependence of adjusted mortality and RRT rate on creatinine, the urine output, and the observation period, we generated contour plots.


Mortality risk was high when absolute creatinine increase was high regardless of the observation period, when percentage creatinine increase was high and the observation period was long, and when oliguria was sustained for a long period of time. Similar contour patterns emerged for RRT. The variability in predictive accuracy was small across different combinations of thresholds and observation periods.


The contour plots presented in this article complement the AKIN definition. A multi-center study should confirm the universal validity of the results presented in this article.


AKI Renal failure Creatinine Urine output Kidney injury AKIN criteria 



This research was supported in part by Grant R01 EB001659 from the National Institute of Biomedical Imaging and Bioengineering (NIBIB) of the National Institutes of Health (NIH). Dr. Joon Lee also holds a Postdoctoral Fellowship from the Natural Sciences and Engineering Research Council of Canada (NSERC).

Conflicts of interest

None of the authors have any financial interests or potential conflicts to disclose.

Supplementary material

134_2012_2767_MOESM1_ESM.pdf (448 kb)
Supplementary material 1 (PDF 449 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2012

Authors and Affiliations

  • Tal Mandelbaum
    • 1
    • 2
  • Joon Lee
    • 2
    • 5
  • Daniel J. Scott
    • 2
  • Roger G. Mark
    • 2
  • Atul Malhotra
    • 3
  • Michael D. Howell
    • 4
  • Daniel Talmor
    • 1
    Email author
  1. 1.Department of Anesthesia, Critical Care and Pain MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  2. 2.Harvard-MIT Division of Health Sciences and TechnologyCambridgeUSA
  3. 3.Division of Pulmonary, Critical Care and Sleep MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  4. 4.Department of Pulmonary, Critical Care and Sleep MedicineBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  5. 5.School of Public Health and Health SystemsUniversity of WaterlooWaterlooCanada

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