STUDY OF MICROALBUMINURIA IN SEPSIS WITH REFERENCE TO APACHE II SCORE

Abstract

Sepsis has very high morbidity and mortality, which leads to major healthcare burden in the world. Though there is far from advancement in the therapeutic options, the mortality rate remains high due to the delay in the diagnosis because of lack of availability of reliable diagnostic methods. In sepsis there is potent activation of inammatory cascade leads to endothelial dysfunction and increase in systemic capillary permeability. In kidney there is loss of barrier integrity and capillary leak in the glomerulus results in increased excretion of albumin in the urine. This study was done to evaluate the degree of microalbuminuria in sepsis in correlation with APACHE II score and to test whether the degree of microalbuminuria could predict the mortality in critically ill sepsis patients. Methodology: The present study was conducted on 50 patients admitted to medical emergency/ Medical ICU in Kamineni Institute of Medical Sciences Narketpally. Spot urine sample was collected within 6 hours and at 24 hours of admission to medical emergency/ICU /ward. Sample testedfor urine micro albumin by using immunoturbidometric method and for urine creatinine by Jaffee method. Urine albumin: creatinine ratio was calculated. (At 6 hours ACR-1 and at 24 hours ACR-2). APACHE II scoring was done at 24 hours of admission. Patients was followed up during hospital stay and the outcome of the patient (i.e., Death/Survival) is recorded. RESULTS: The present study included 50 patients, among which 31 were males and 19 were females. Mean age was 43.5 years. Mortality was 38%. Mortality was more among male patients than in female. APACHE II score ranges from 6 - 37, mean APACHE II among survivors were 16.35 with Standard Deviation of 6.78 and among non survivors were 25.47 with Standard Deviation of 6.93 with p value of <0.0001 for predicting mortality. Urine ACR 1 was 74.06±20.83 µgm/mg among survivors and 164.53±46.61 µgm /mg among non survivors and ACR 2 was 45.81±17.92µgm/mg among survivors and 157.84±36.96 µgm/mg among non survivors. Both were statistically signicant with p value of 0.0001 for predicting mortality. The degree of microalbuminuria correlates with disease severity. CONCLUSION: Signicant microalbuminuria is predictive of mortality which is equivalent to APACHE II score. Microalbuminuria is an inexpensive and rapid diagnostic tool. Serial measurements may help in the clinical assessment of critically ill patients at risk of worse prognosis, even in resource poor areas.