The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database

Jean Louis Vincent; Andrew Ferguson; Peter Pickkers; ICON Investigators; Indulis Vanags; Viesturs Liguts

doi:10.1186/s13054-020-02858-x

The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database

Jean Louis Vincent, Andrew Ferguson, Peter Pickkers, ICON Investigators, Indulis Vanags (Member of the Working Group), Viesturs Liguts (Member of the Working Group)

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Abstract

Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.

Original language	English
Article number	171
Journal	Critical Care
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s13054-020-02858-x
Publication status	Published - 23 Apr 2020
Externally published	Yes

Keywords*

Mortality
Renal replacement therapy
Urine output

Field of Science*

3.2 Clinical medicine

Publication Type*

1.1. Scientific article indexed in Web of Science and/or Scopus database

Access to Document

10.1186/s13054-020-02858-xLicence: CC BY

The clinical relevance of oliguriaFinal published version, 760 KBLicence: CC BY

Cite this

@article{0944836a7ecb48c086f33c74d9900342,

title = "The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database",

abstract = "Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.",

keywords = "Mortality, Renal replacement therapy, Urine output",

author = "Vincent, {Jean Louis} and Andrew Ferguson and Peter Pickkers and Jakob, {Stephan M.} and Ulrich Jaschinski and Almekhlafi, {Ghaleb A.} and Marc Leone and Majid Mokhtari and Fontes, {Luis E.} and Bauer, {Philippe R.} and Yasser Sakr and {ICON Investigators} and Esmael Tomas and Bibonge, {Eric Amisi} and Boubaker Charra and Mamoun Faroudy and Linda Doedens and Zane Farina and David Adler and Cecile Balkema and Adri Kok and Sami Alaya and Hedi Gharsallah and Dritan Muzha and Atanas Temelkov and Georgi Georgiev and Georgi Simeonov and Georgi Tsaryanski and Silvi Georgiev and Ali Seliman and Srdan Vrankovic and Zeljko Vucicevic and Ivan Gornik and Bruno Barsic and Ino Husedzinovic and Pavel Pavlik and Jan Manak and Eva Kieslichova and Radovan Turek and Michal Fischer and Radka Valkova and Lukas Dadak and Pavel Dostal and Jan Malaska and Roman Hajek and Alexandra {\v Z}idkov{\'a} and Pavel Lavicka and Joel Starkopf and Zurab Kheladze and Indulis Vanags and Viesturs Liguts",

note = "Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: {\textcopyright} 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.",

year = "2020",

month = apr,

day = "23",

doi = "10.1186/s13054-020-02858-x",

language = "English",

volume = "24",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd.",

number = "1",

}

TY - JOUR

T1 - The clinical relevance of oliguria in the critically ill patient

T2 - Analysis of a large observational database

AU - Vincent, Jean Louis

AU - Ferguson, Andrew

AU - Pickkers, Peter

AU - Jakob, Stephan M.

AU - Jaschinski, Ulrich

AU - Almekhlafi, Ghaleb A.

AU - Leone, Marc

AU - Mokhtari, Majid

AU - Fontes, Luis E.

AU - Bauer, Philippe R.

AU - Sakr, Yasser

AU - ICON Investigators

A2 - Tomas, Esmael

A2 - Bibonge, Eric Amisi

A2 - Charra, Boubaker

A2 - Faroudy, Mamoun

A2 - Doedens, Linda

A2 - Farina, Zane

A2 - Adler, David

A2 - Balkema, Cecile

A2 - Kok, Adri

A2 - Alaya, Sami

A2 - Gharsallah, Hedi

A2 - Muzha, Dritan

A2 - Temelkov, Atanas

A2 - Georgiev, Georgi

A2 - Simeonov, Georgi

A2 - Tsaryanski, Georgi

A2 - Georgiev, Silvi

A2 - Seliman, Ali

A2 - Vrankovic, Srdan

A2 - Vucicevic, Zeljko

A2 - Gornik, Ivan

A2 - Barsic, Bruno

A2 - Husedzinovic, Ino

A2 - Pavlik, Pavel

A2 - Manak, Jan

A2 - Kieslichova, Eva

A2 - Turek, Radovan

A2 - Fischer, Michal

A2 - Valkova, Radka

A2 - Dadak, Lukas

A2 - Dostal, Pavel

A2 - Malaska, Jan

A2 - Hajek, Roman

A2 - Židková, Alexandra

A2 - Lavicka, Pavel

A2 - Starkopf, Joel

A2 - Kheladze, Zurab

A2 - Vanags, Indulis

A2 - Liguts, Viesturs

N1 - Funding Information: Marc Leone reports receiving consulting fees from Amomed and Aguettant; lecture fees from MSD, Pfizer, Octapharma, 3 M, Aspen, Orion; travel support from LFB; and grant support from PHRC IR and his institution. JLV is the Editor-in-Chief of Critical Care. The other authors declare that they have no relevant financial interests. Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

PY - 2020/4/23

Y1 - 2020/4/23

N2 - Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.

AB - Background: Urine output is widely used as one of the criteria for the diagnosis and staging of acute renal failure, but few studies have specifically assessed the role of oliguria as a marker of acute renal failure or outcomes in general intensive care unit (ICU) patients. Using a large multinational database, we therefore evaluated the occurrence of oliguria (defined as a urine output < 0.5 ml/kg/h) in acutely ill patients and its association with the need for renal replacement therapy (RRT) and outcome. Methods: International observational study. All adult (> 16 years) patients in the ICON audit who had a urine output measurement on the day of admission were included. To investigate the association between oliguria and mortality, we used a multilevel analysis. Results: Of the 8292 patients included, 2050 (24.7%) were oliguric during the first 24 h of admission. Patients with oliguria on admission who had at least one additional 24-h urine output recorded during their ICU stay (n = 1349) were divided into three groups: transient - oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged - oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent - oliguria persisting for the whole ICU stay or again present at the end of the ICU stay (n = 818 [60.6%]). ICU and hospital mortality rates were higher in patients with oliguria than in those without, except for patients with transient oliguria who had significantly lower mortality rates than non-oliguric patients. In multilevel analysis, the need for RRT was associated with a significantly higher risk of death (OR = 1.51 [95% CI 1.19-1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97-1.34], p = 0.103). Conclusions: Oliguria is common in ICU patients and may have a relatively benign nature if only transient. The duration of oliguria and need for RRT are associated with worse outcome.

KW - Mortality

KW - Renal replacement therapy

KW - Urine output

UR - http://www.scopus.com/inward/record.url?scp=85084030262&partnerID=8YFLogxK

U2 - 10.1186/s13054-020-02858-x

DO - 10.1186/s13054-020-02858-x

M3 - Article

C2 - 32326981

AN - SCOPUS:85084030262

SN - 1364-8535

VL - 24

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 171

ER -

The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database

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