• Selena Z Kuo, Katja Dettmer, Medini K Annavajhala, David H Chong, Anne-Catrin Uhlemann, Julian A Abrams, Peter J Oefner, and Daniel E Freedberg.
• Department of Medicine, Columbia University Medical Center, New York, NY, USA. Electronic address: szk9009@nyp.org.
• J Crit Care. 2021 Jun 1; 63: 15-21.

Purpose3-indoxyl sulfate (3-IS) is an indole metabolism byproduct produced by commensal gut bacteria and excreted in the urine; low urinary 3-IS has been associated with increased mortality in bone marrow transplant recipients. This study investigated urinary 3-IS and patient outcomes in the ICU.Materials And MethodsProspective study that collected urine samples, rectal swabs, and clinical data on 78 adult ICU patients at admission and again 72 h later. Urine was analyzed for 3-IS by mass spectrometry.ResultsMedian urinary 3-IS levels were 17.1 μmol/mmol creatinine (IQR 9.5 to 26.2) at admission and 15.6 (IQR 4.2 to 30.7) 72 h later. 22% of patients had low 3-IS (≤6.9 μmol/mmol) on ICU admission and 28% after 72 h. Low 3-IS at 72 h was associated with fewer ICU-free days (22.5 low versus 26 high, p = 0.03) and with death during one year of follow-up (36% low versus 9% high 3-IS, p < 0.01); there was no detectable difference in 30-day mortality (18% low versus 5% high, p = 0.07).ConclusionsLow urinary 3-IS level 72 h after ICU admission was associated with fewer ICU-free days and with increased one-year but not 30-day mortality. Further studies should investigate urinary 3-IS as an ICU biomarker.Copyright © 2021 Elsevier Inc. All rights reserved.

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