Association Between 24-hour Urine Volume and 28-day Intensive Care Unit Mortality in Sepsis Patients: a Multi-center Retrospective Cohort Study

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Dec 11

PMID 39659626

Authors

Yuzhan Lin

Weiguo Lin

Cheng Fu

Ruixue Sun

WeiLi Hong

Xinglin Chen

Shaorong Yan

Affiliations

Soon will be listed here.

Abstract

Background: Sepsis is defined as a dysregulated host response to infection that results in life-threatening organ dysfunction. The 24-hour urine volume plays a crucial role in assessing the prognosis of septic patients. This study aims to investigate the relationship between 24-hour urine volume and 28-day intensive care unit (ICU) mortality in septic patients and exploring the dose-response relationship between these variables.

Methods: This retrospective cohort study analyzed data from 7,218 sepsis patients in the eICU Collaborative Research Database. Logistic regression models and generalized additive models were used to examine the relationship between 24-hour urine volume and 28-day ICU mortality.

Results: A negative correlation was found between 24-hour urine volume and ICU 28-day mortality. In the fully adjusted model, each 50 mL increase in 24-hour urine volume significantly reduced mortality risk by 1% (OR = 0.99, 95% CI = 0.98-0.99, < 0.001). A nonlinear dose-response relationship was observed, with an inflection point at ~1,663.5 ml. Below this threshold, increased urine volume was significantly associated with reduced mortality risk (OR = 0.97, 95% CI: 0.96-0.98, < 0.001), while above this point, the relationship was not statistically significant.

Conclusion: This study demonstrates a non-linear negative correlation between 24-hour urine volume and 28-day ICU mortality in sepsis patients.

References

Lengton R, van der Willik E, de Rooij E, Meuleman Y, le Cessie S, Michels W . Effect of residual kidney function and dialysis adequacy on chronic pruritus in dialysis patients. Nephrol Dial Transplant. 2022; 38(6):1508-1518. PMC: 10229298. DOI: 10.1093/ndt/gfac341. View

De Backer D, Hajjar L, Monnet X . Vasoconstriction in septic shock. Intensive Care Med. 2024; 50(3):459-462. DOI: 10.1007/s00134-024-07332-8. View

Singer M, Deutschman C, Seymour C, Shankar-Hari M, Annane D, Bauer M . The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8):801-10. PMC: 4968574. DOI: 10.1001/jama.2016.0287. View

Lerolle N, Nochy D, Guerot E, Bruneval P, Fagon J, Diehl J . Histopathology of septic shock induced acute kidney injury: apoptosis and leukocytic infiltration. Intensive Care Med. 2009; 36(3):471-8. DOI: 10.1007/s00134-009-1723-x. View

Pollard T, Johnson A, Raffa J, Celi L, Mark R, Badawi O . The eICU Collaborative Research Database, a freely available multi-center database for critical care research. Sci Data. 2018; 5:180178. PMC: 6132188. DOI: 10.1038/sdata.2018.178. View

Raia L, Zafrani L . Endothelial Activation and Microcirculatory Disorders in Sepsis. Front Med (Lausanne). 2022; 9:907992. PMC: 9204048. DOI: 10.3389/fmed.2022.907992. View

Pais T, Jorge S, Antonio Lopes J . Acute Kidney Injury in Sepsis. Int J Mol Sci. 2024; 25(11). PMC: 11172431. DOI: 10.3390/ijms25115924. View

Peerapornratana S, Manrique-Caballero C, Gomez H, Kellum J . Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment. Kidney Int. 2019; 96(5):1083-1099. PMC: 6920048. DOI: 10.1016/j.kint.2019.05.026. View

Shafi T, Jaar B, Plantinga L, Fink N, Sadler J, Parekh R . Association of residual urine output with mortality, quality of life, and inflammation in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Am J Kidney Dis. 2010; 56(2):348-58. PMC: 2910835. DOI: 10.1053/j.ajkd.2010.03.020. View

10.

Luhr R, Cao Y, Soderquist B, Cajander S . Trends in sepsis mortality over time in randomised sepsis trials: a systematic literature review and meta-analysis of mortality in the control arm, 2002-2016. Crit Care. 2019; 23(1):241. PMC: 6610784. DOI: 10.1186/s13054-019-2528-0. View

11.

Sathaporn N, Khwannimit B . Validation the performance of New York Sepsis Severity Score compared with Sepsis Severity Score in predicting hospital mortality among sepsis patients. J Crit Care. 2019; 53:155-161. DOI: 10.1016/j.jcrc.2019.06.017. View

12.

Moskowitz A, Berg K, Grossestreuer A, Balaji L, Liu X, Cocchi M . Thiamine for Renal Protection in Septic Shock (TRPSS): A Randomized, Placebo-controlled, Clinical Trial. Am J Respir Crit Care Med. 2023; 208(5):570-578. PMC: 10492240. DOI: 10.1164/rccm.202301-0034OC. View

13.

Avila M, Zanetta D, Abdulkader R, Yu L, Burdmann E . Urine volume in acute kidney injury: how much is enough?. Ren Fail. 2009; 31(10):884-90. DOI: 10.3109/08860220903216089. View

14.

Tang F, Zhao X, Xu L, Zhang J, Ao H, Peng C . Endothelial dysfunction: Pathophysiology and therapeutic targets for sepsis-induced multiple organ dysfunction syndrome. Biomed Pharmacother. 2024; 178:117180. DOI: 10.1016/j.biopha.2024.117180. View

15.

Li Y, She Y, Fu L, Zhou R, Xiang W, Luo L . Association Between Red Cell Distribution Width and Hospital Mortality in Patients with Sepsis. J Int Med Res. 2021; 49(4):3000605211004221. PMC: 8033474. DOI: 10.1177/03000605211004221. View

16.

Hotchkiss R, Karl I . The pathophysiology and treatment of sepsis. N Engl J Med. 2003; 348(2):138-50. DOI: 10.1056/NEJMra021333. View

17.

Lei C, Xie J, Ran Q, Zhang M . Non-linear relationship between age and subfoveal choroidal thickness in Chinese patients with proliferative diabetic retinopathy. World J Diabetes. 2024; 15(9):1903-1915. PMC: 11372635. DOI: 10.4239/wjd.v15.i9.1903. View

18.

Kalantar-Zadeh K, Regidor D, Kovesdy C, Van Wyck D, Bunnapradist S, Horwich T . Fluid retention is associated with cardiovascular mortality in patients undergoing long-term hemodialysis. Circulation. 2009; 119(5):671-9. PMC: 2773290. DOI: 10.1161/CIRCULATIONAHA.108.807362. View

19.

Kounatidis D, Vallianou N, Psallida S, Panagopoulos F, Margellou E, Tsilingiris D . Sepsis-Associated Acute Kidney Injury: Where Are We Now?. Medicina (Kaunas). 2024; 60(3). PMC: 10971830. DOI: 10.3390/medicina60030434. View

20.

Stanski N, Cvijanovich N, Fitzgerald J, Bigham M, Wong H . Severe acute kidney injury is independently associated with mortality in children with septic shock. Intensive Care Med. 2020; 46(5):1050-1051. PMC: 7677896. DOI: 10.1007/s00134-020-05940-8. View