Microalbuminuria As A Biomarker Of Sepsis And Its Prognostic Significance In Critically Ill Patients – A One Year Hospital Based Cross Sectional Study

Abstract

Background and objectives There is no single biomarker which can serve as the diagnostic parameter in the diagnosis of sepsis among the patients with SIRS. This study was aimed to evaluate the role of microalbuminuria as a biomarker of sepsis and also to predict ICU mortality. Methodology This one year cross sectional study was done from January 2014 to December 2014 in the Department of Medicine, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum. Based on ACCP and SCCM criteria, a total of 65 patients with diagnosis of SIRS enrolled and evaluated for the presence of microalbuminuria at admission and 24 hours after admission. Results Most of the patients were males (63.08%) and male to female ratio was 1.70:1. The commonest age group was between 41 to 50 years (27.69%) and the mean age was 51.12 ± 15.87 years. Fever was the common clinical presentation (95.38%). Diagnosis of severe sepsis was noted in 58.46% of the patients. Mortality was note din 56.92% of the patients and length of hospital stay was from 4-7 days in most of the patients (41.54%). UACR at admission was >0.20 in 92.31% of the patients and at 24 hours after admission it was >0.20 in 87.69% of the patients. UACR of >0.20 at admission showed 100% sensitivity in predicting sepsis (83.33% specificity, 98.33% PPV, 100% NPV with positive likelihood ratio of 6) and similar sensitivity pattern was noted with regard to 24 hours UACR (p<0.001). The mean UACR at admission in patients with sepsis was significantly high at admission as well as at 24 hours after admission (p<0.050). With regard to mortality, sensitivity of > 0.20 UACR at admission in predicting mortality was 100% with 17.86% specificity, 61.67% PPV and 100% NPV and the positive likelihood ratio was 1.22 which was nearly same for values of UACR at 24 hours after admission. No association was found between length of hospital stay and UACR (p>0.050). Conclusion and interpretation Microalbuminuria (UACR >0.20) is a reliable biomarker in the determination of sepsis in patients admitted with SIRS but has limited ability in predicting ICU mortality.