• Jun-Ping Qin, Xiang-You Yu, Chuan-Yun Qian, Shu-Sheng Li, Tie-He Qin, Er-Zhen Chen, Jian-Dong Lin, Yu-Hang Ai, Da-Wei Wu, De-Xin Liu, Ren-Hua Sun, Zhen-Jie Hu, Xiang-Yuan Cao, Fa-Chun Zhou, Zhen-Yang He, Li-Hua Zhou, You-Zhong An, Yan Kang, Xiao-Chun Ma, Ming-Yan Zhao, Li Jiang, Yuan Xu, Bin Du, and China Critical Care Clinical Trial Group (CCCCTG).
• Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing 100730; Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
• Chin. Med. J. 2016 Sep 5; 129 (17): 2050-7.

BackgroundUrine output (UO) is an essential criterion of the Kidney Disease Improving Global Outcomes (KDIGO) definition and classification system for acute kidney injury (AKI), of which the diagnostic value has not been extensively studied. We aimed to determine whether AKI based on KDIGO UO criteria (KDIGOUO) could improve the diagnostic and prognostic accuracy, compared with KDIGO serum creatinine criteria (KDIGOSCr).MethodsWe conducted a secondary analysis of the database of a previous study conducted by China Critical Care Clinical Trial Group (CCCCTG), which was a 2-month prospective cohort study (July 1, 2009 to August 31, 2009) involving 3063 patients in 22 tertiary Intensive Care Units in Mainland of China. AKI was diagnosed and classified separately based on KDIGOUOand KDIGOSCr. Hospital mortality of patients with more severe AKI classification based on KDIGOUOwas compared with other patients by univariate and multivariate regression analyses.ResultsThe prevalence of AKI increased from 52.4% based on KDIGOSCrto 55.4% based on KDIGOSCrcombined with KDIGOUO. KDIGOUOalso resulted in an upgrade of AKI classification in 7.3% of patients, representing those with more severe AKI classification based on KDIGOUO. Compared with non-AKI patients or those with maximum AKI classification by KDIGOSCr, those with maximum AKI classification by KDIGOUOhad a significantly higher hospital mortality of 58.4% (odds ratio [OR]: 7.580, 95% confidence interval [CI]: 4.141-13.873, P< 0.001). In a multivariate logistic regression analysis, AKI based on KDIGOUO (OR: 2.891, 95% CI: 1.964-4.254, P< 0.001), but not based on KDIGOSCr (OR: 1.322, 95% CI: 0.902-1.939, P = 0.152), was an independent risk factor for hospital mortality.ConclusionUO was a criterion with additional value beyond creatinine criterion for AKI diagnosis and classification, which can help identify a group of patients with high risk of death.

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