Department of Critical Care, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, The Netherlands.
Intensive Care Med. 2018 Oct;44(10):1699-1708. doi: 10.1007/s00134-018-5359-6. Epub 2018 Sep 7.
Patients with reduced muscle mass have a worse outcome, but muscle mass is difficult to quantify in the ICU. Urinary creatinine excretion (UCE) reflects muscle mass, but has not been studied in critically ill patients. We evaluated the relation of baseline UCE with short-term and long-term mortality in patients admitted to our ICU.
Patients who stayed ≥ 24 h in the ICU with UCE measured within 3 days of admission were included. We excluded patients who developed acute kidney injury stage 3 during the first week of ICU stay. As muscle mass is considerably higher in men than women, we used sex-stratified UCE quintiles. We assessed the relation of UCE with both in-hospital mortality and long-term mortality.
From 37,283 patients, 6151 patients with 11,198 UCE measurements were included. Mean UCE was 54% higher in males compared to females. In-hospital mortality was 17%, while at 5-year follow-up, 1299 (25%) patients had died. After adjustment for age, sex, estimated glomerular filtration rate, body mass index, reason for admission and disease severity, patients in the lowest UCE quintile had an increased in-hospital mortality compared to the patients in the highest UCE quintile (OR 2.56, 95% CI 1.96-3.34). For long-term mortality, the highest risk was also observed for patients in the lowest UCE quintile (HR 2.32, 95% CI 1.89-2.85), independent of confounders.
In ICU patients without severe renal dysfunction, low urinary creatinine excretion is associated with short-term and long-term mortality, independent of age, sex, renal function and disease characteristics, underscoring the role of muscle mass as risk factor for mortality and UCE as relevant biomarker.
肌肉减少症患者的预后较差，但在 ICU 中很难对肌肉量进行定量评估。尿肌酐排泄量（UCE）反映肌肉量，但尚未在危重症患者中进行研究。我们评估了 ICU 入院时 UCE 与短期和长期死亡率的关系。
纳入 ICU 入住时间≥24 小时且入院后 3 天内测量 UCE 的患者。我们排除了在 ICU 入住第一周发生急性肾损伤 3 期的患者。由于男性的肌肉量显著高于女性，我们使用了按性别分层的 UCE 五分位数。我们评估了 UCE 与院内死亡率和长期死亡率的关系。
从 37283 名患者中，纳入了 6151 名患者的 11198 次 UCE 测量值。男性的 UCE 平均值比女性高 54%。院内死亡率为 17%，5 年随访时，有 1299 名（25%）患者死亡。在调整了年龄、性别、估计肾小球滤过率、体重指数、入院原因和疾病严重程度后，最低 UCE 五分位数的患者与最高 UCE 五分位数的患者相比，院内死亡率增加（OR 2.56，95%CI 1.96-3.34）。对于长期死亡率，最低 UCE 五分位数的患者风险最高（HR 2.32，95%CI 1.89-2.85），独立于混杂因素。
在无严重肾功能障碍的 ICU 患者中，低 UCE 与短期和长期死亡率相关，独立于年龄、性别、肾功能和疾病特征，强调了肌肉量作为死亡率的危险因素和 UCE 作为相关生物标志物的作用。
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