• Nicolás Nin, Raúl Lombardi, Fernando Frutos-Vivar, Andrés Esteban, José A Lorente, Niall D Ferguson, Javier Hurtado, Carlos Apezteguia, Laurent Brochard, Fréderique Schortgen, Konstantinos Raymondos, Vinko Tomicic, Luis Soto, Marco González, Peter Nightingale, Fekri Abroug, Paolo Pelosi, Yaseen Arabi, Rui Moreno, Antonio Anzueto, and VENTILA Group.
• Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario de Getafe, Madrid, Spain. niconin@hotmail.com
• Shock. 2010 Aug 1; 34 (2): 109-16.

AbstractEmerging evidence suggests that minor changes in serum creatinine concentrations are associated with increased hospital mortality rates. However, whether serum creatinine concentration (SCr) on admission and its change are associated with an increased mortality rate in mechanically ventilated patients is not known. We have conducted an international, prospective, observational cohort study enrolling adult intensive care unit patients under mechanical ventilation (MV). Recursive partitioning was used to determine the values of SCr at the start of MV (SCr0) and the change in SCr ([DeltaSCr] defined as the maximal difference between the value at start of MV [day 0] and the value on MV day 2 at 8:00 am) that best discriminate mortality. In-hospital mortality, adjusted by a proportional hazards model, was the primary outcome variable. A total of 2,807 patients were included; median age was 59 years and median Simplified Acute Physiology Score II was 44. All-cause in-hospital mortality was 44%. The variable that best discriminated outcome was a SCr0 greater than 1.40 mg/dL (mortality, 57% vs. 36% for patients with SCr0

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