Microalbuminuria: A biomarker of sepsis and efficacy of treatment in patients admitted to a medical intensive care unit of a tertiary referral center

Background: The outcome of sepsis is significantly affected by early institution of goal-directed therapies and hence, the search for an early marker of sepsis continues. Aims and Objectives: To observe microalbuminuria levels between patients with sepsis and those without sepsis s admitted to the medical intensive care unit (MICU) of a tertiary referral centre (primary) as also to assess the change in microalbuminuria levels in the first 24 hours as a predictor of mortality and morbidity relative to the APACHE II and SOFA scores. Materials and Methods: This was a prospective observational study where 125 patients with sepsis and 38 without were assessed. Trend of microalbuminuria was assessed from the change of ACR value within 6 hours of admission (ACR1) to the ACR value at 24 hours (ACR2) in both groups of patients. Results and Conclusion: Significantly higher levels of microalbuminuria were found among patients with sepsis as compared to those without sepsis. The levels decreased in survivors with sepsis after 24 hours, whereas they continued to remain almost at the same levels among those without sepsis. The change in microalbuminuria levels over 24 hours can be used to measure the effectiveness of therapy. Persistence of high levels or increasing trend of microalbuminuria levels over 24 hours was found to be a predictor of a poor outcome. A high level of microalbuminuria at 24 hours and increasing trend of microalbuminuria also predicted mortality better than APACHE II and SOFA scores

Clinical characteristics and outcomes of patients with acute lung injury and ARDS

Background : Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are critical illnesses associated with significant morbidity and mortality. Aims : This was designed to assess various etiologies of ALI/ARDS, to determine the correlation between the diagnostic criteria and need of mechanical ventilation, and to correlate biochemical factors with the outcome of patients. Settings and Design : An observational, prospective study was conducted in a medical intensive care unit (MICU) of a tertiary care hospital, for a period of 1 year. Materials and Methods : This study encompassed 58 consecutive cases of ALI/ARDS admitted to a MICU as per AECC guidelines. Patients excluded were with cardiac failure, chronic kidney diseases with fluid overload, and age below 12 years. Statistical Analysis : The data were analysed applying χ2 -test, multivariate logistic regression analysis of significance, using computer-based program SPSS. Results : There were more males (74%) than females, and presentation was more common in the younger age group, with a total mortality of 57%. Factors attributable for ALI/ARDS were malaria in 16 patients (27.6%), leptospirosis in 12 (20.7%), malaria with dengue in 3 (5.2%), undiagnosed fever in 16 (27.6%), pneumonia in 8 (13.8%), urinary tract infection in 2 (3.4%), and pancreatitis in 1 (1.7%) patient. Out of 41 patients with PaO 2 /FiO 2 200, 11 patients though initially managed on noninvasive ventilation (NIV) subsequently required invasive ventilation, and remaining six were successfully managed on NIV. Out of 41 patients requiring mechanical ventilation, 36 had LIS >2.5, whereas only 3 out of 17 patients with LIS <2.5 required mechanical ventilation. Conclusion : Malaria, leptospirosis, and undiagnosed fever were the main etiologies followed by pneumonia, urinary tract infections, and pancreatitis. Both the PaO 2 /FiO 2 ratio and lung injury score (LIS) at the time of admission were significant predictors of the outcome and of necessity of mechanical ventilation. PaO 2 /FiO 2 was a better predictor of duration of stay at the intensive care unit than the LIS. Sepsis, acidosis, hypotension, and multiorgan failure were individual predictors of mortality in patients with ALI/ARDS while age, sex, anemia, thrombocytopenia, renal failure, hepatic failure, and X-ray picture were not predictors of the outcome