Abstract
Purpose
Declining kidney function has been associated with adverse hospital outcome in cancer patients. ICU literature suggests that small changes in serum creatinine are associated with poor outcome. We hypothesized that reductions in renal function previously considered trivial would predict a poor outcome in critically ill patients with malignant disease. We evaluated the effects on hospital mortality and ICU length of stay of small changes in creatinine following admission to the intensive care unit.
Methods
We conducted a retrospective cohort study utilizing clinical, laboratory and pharmacy data collected from 3,795 patients admitted to the University of Texas M.D. Anderson Cancer Center's Intensive Care Unit. We conducted univariate and multivariate regression analysis to determine those factors associated with adverse ICU and hospital outcome.
Results
Increases in creatinine as small as 10% (0.2 mg/dl) were associated with prolonged ICU stay (5 days vs 6.6 days, p < 0.001) and increased mortality (14.6% vs 25.5%, p < 0.0001). Patients with a 25% rise in creatinine during the first 72 h of ICU admission were twice as likely to die in the hospital (14.3% vs 30.1%, p < 0.001). RIFLE criteria were accurate predictors of outcome, though they missed much of the risk of even smaller increases in creatinine.
Conclusions
Even small rises in serum creatinine following admission to the ICU are associated with increased morbidity and mortality in oncologic patients. The poor outcome in those with rising creatinine could not be explained by severity of illness or other risk factors. These small changes in creatinine may not be trivial, and should be regarded as evidence of a decline in an individual patient's condition.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kierdorf H, Sieberth HG (1995) Continuous treatment modalities in acute renal failure. Nephrol Dial Transplant 10(11):2001–2008
Vandijck DM, Oeyen S, Decruyenaere JM, Annemans L, Hoste EA (2007) Acute kidney injury, length of stay, and costs in patients hospitalized in the intensive care unit. Acta Clin Belg Suppl 2:341–345
Cruz DN, Ronco C (2007) Acute kidney injury in the intensive care unit: current trends in incidence and outcome. Crit Care 11(4):149
Cantarovich F, Verho MT (1996) A simple prognostic index for patients with acute renal failure requiring dialysis. French multicentric prospective study on furosemide in acute renal failure requiring dialysis. Ren Fail 18(4):585–592
Ostermann M, Chang R (2008) Correlation between the aki classification and outcome. Crit Care 12(6):R144
Shlipak MG, Stehman-Breen C, Vittinghoff E, Lin F, Varosy PD, Wenger NK, Furberg CD (2004) Creatinine levels and cardiovascular events in women with heart disease: do small changes matter? Am J Kidney Dis 43(1):37–44
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16(11):3365–3370
Brown JR, Cochran RP, Dacey LJ, Ross CS, Kunzelman KS, Dunton RF, Braxton JH, Charlesworth DC, Clough RA, Helm RE, Leavitt BJ, Mackenzie TA, O’Connor GT (2006) Perioperative increases in serum creatinine are predictive of increased 90-day mortality after coronary artery bypass graft surgery. Circulation 114(1 Suppl):I409–I413
Kilo J, Margreiter JE, Ruttmann E, Bonatti JO, Laufer G (2005) Slightly elevated serum creatinine predicts renal failure requiring hemofiltration after cardiac surgery. Heart Surg Forum 8(1):E34–E38
Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M (2004) Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 15(6):1597–1605
Soares M, Salluh JIF, Carvalho MS, Darmon M, Rocco JR, Spector N (2006) Prognosis of critically ill patients with cancer and acute renal dysfunction. J Clin Oncol 24(24):4003–4010. doi:10.1200/jco.2006.05.7869
Parikh CR, Yarlagadda SG, Storer B, Sorror M, Storb R, Sandmaier B (2008) Impact of acute kidney injury on long-term mortality after nonmyeloablative hematopoietic cell transplantation. Biol Blood Marrow Transplant 14(3):309–315
Groeger JS, Aurora RN (2001) Intensive care, mechanical ventilation, dialysis, and cardiopulmonary resuscitation. Implications for the patient with cancer. Crit Care Clin 17(3):791–803
Munker R, Hill U, Jehn U, Kolb HJ, Schalhorn A (1998) Renal complications in acute leukemias. Haematologica 83(5):416–421
Lanore JJ, Brunet F, Pochard F, Bellivier F, Dhainaut JF, Vaxelaire JF, Giraud T, Dreyfus F, Dreyfuss D, Chiche JD et al (1991) Hemodialysis for acute renal failure in patients with hematologic malignancies. Crit Care Med 19(3):346–351
Benoit DD, Hoste EA, Depuydt PO, Offner FC, Lameire NH, Vandewoude KH, Dhondt AW, Noens LA, Decruyenaere JM (2005) Outcome in critically ill medical patients treated with renal replacement therapy for acute renal failure: comparison between patients with and those without haematological malignancies. Nephrol Dial Transplant 20(3):552–558. doi:10.1093/ndt/gfh637
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (adqi) group. Crit Care 8(4):R204–R212
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11(2):R31
Benoit DD, Hoste EA (2010) Acute kidney injury in critically ill patients with cancer. Crit Care Clin 26(1):151–179
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, Sprung CL, Colardyn F, Blecher S (1998) Use of the sofa score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “Sepsis-related problems” Of the european society of intensive care medicine. Crit Care Med 26(11):1793–1800
Nates JL, Cardenas-Turanzas M, Wakefield C, Kish Wallace S, Shaw A, Samuels JA, Ensor J, Price KJ (2010) Automating and simplifying the sofa score in critically ill patients with cancer. Health Inform J 16(1):35–47
Hoste EA, Clermont G, Kersten A, Venkataraman R, Angus DC, De Bacquer D, Kellum JA (2006) Rifle criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 10(3):R73
Conflict of Interest
This work was supported by the NIH/NIDDK under grant #DK-065951. None of the authors has any significant conflict of interest to report.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Samuels, J., Ng, C.S., Nates, J. et al. Small increases in serum creatinine are associated with prolonged ICU stay and increased hospital mortality in critically ill patients with cancer. Support Care Cancer 19, 1527–1532 (2011). https://doi.org/10.1007/s00520-010-0978-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-010-0978-7