Key result
First-day ICU urine output ≤0.3 ml/kg/h linked to ~52% higher hospital mortality versus >0.5 ml/kg/h.
Why the study?
The prognostic value of urine output measured on ICU entry remains debated.
Is lower urine output during the first 24 hours of ICU admission associated with increased hospital mortality in unselected critically ill patients?
Cohort (n=21,207)
Is lower urine output during the first 24 hours of ICU admission associated with increased hospital mortality in unselected critically ill patients?
Hazard Ratio: 1.52 (95% CI 1.38–1.67)
Absolute Event Rate: 18.29% vs 7.67%
Urine output during the first 24 hours of ICU admission is an independent predictor of hospital mortality, with lower output associated with higher risk.
BACKGROUND AND OBJECTIVE: Urine output (UO) is routinely measured in the intensive care unit (ICU) but its prognostic value remains debated. The study aimed to investigate the association between day 1 UO and hospital mortality. METHODS: Clinical data were abstracted from the Multiparameter Intelligent Monitoring in Intensive Care II (version 2.6) database. UO was recorded for the first 24 h after ICU entry, and was classified into three categories: UO >0.5, 0.3-0.5 and ≤0.3 ml/kg per hour. The primary endpoint was the hospital mortality. Four models were built to adjust for the hazards ratio of mortality. RESULTS: A total of 21,207 unselected ICU patients including 2,401 non-survivors and 18,806 survivors were included (mortality rate 11.3 %). Mortality rate increased progressively across UO categories: >0.5 (7.67 %), 0.3-0.5 (11.27 %) and ≤0.3 ml/kg/h (18.29 %), and this relationship remained statistically significant after rigorous control of confounding factors with the Cox proportional hazards regression model. With UO >0.5 as the referent group, the hazards ratios for UO 0.3-0.5 and UO ≤0.3 were 1.41 (95 % CI 1.29-1.54) and 1.52 (95 % CI 1.38-1.67), respectively. CONCLUSION: UO obtained on ICU entry is an independent predictor of mortality irrespective of diuretic use. It would be interesting to examine whether strategies to increase UO would improve clinical outcome.
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Zhang et al. (2014) conducted a cohort in critically ill patients (n=21,207). Urine output ≤0.3 ml/kg/h vs. Urine output >0.5 ml/kg/h was evaluated on hospital mortality (HR 1.52, 95% CI 1.38-1.67). Urine output ≤0.3 ml/kg/h during the first 24 hours of ICU admission was associated with higher hospital mortality compared to >0.5 ml/kg/h (18.29% vs 7.67%; HR 1.52, 95% CI 1.38-1.67).
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