• George Kuo, Jia-Jin Chen, Chieh-Li Yen, Pei-Chun Fan, Cheng-Chia Lee, and Chih-Hsiang Chang.
• Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taiwan.
• J Crit Care. 2022 Dec 1; 72: 154142154142.

BackgroundEarly prediction of AKI is crucial for critically ill patients. We investigated the association between small increase in creatinine and subsequent severe AKI in ICU patients.MethodsWe conducted this retrospective cohort with a multi-institutional database between 2007 and 2019. We included adult patients admitted to the ICU with creatinine changes that did not meet the criteria for AKI diagnosis within 48 h of ICU admission. The outcomes were stage 2 or 3 AKI, kidney replacement therapy, and mortality.ResultsWe identified 44,805 patients and divided them into 3 groups by baseline creatinine levels: <1 mg/dL, 1 to 2 mg/dL, and ≥ 2 mg/dL. Compared with patients with higher baseline creatinine levels, patients with normal baseline creatinine levels had fewer comorbidities and less severe condition at ICU admission. The odds ratios of their outcomes increased exponentially with creatinine elevation within the first 48 h of ICU admission. The increasing odds ratios were more prominent in patients with normal baseline creatinine (P for interaction <0.001).ConclusionSmall creatinine elevation within the first 48 h of ICU admission was strongly associated with the AKI, kidney replacement therapy, and death. This association was more prominent in patients with normal baseline creatinine.Copyright © 2022 Elsevier Inc. All rights reserved.

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