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

Jean Louis Vincent; Andrew Ferguson; Peter Pickkers; Stephan M. Jakob; Ulrich Jaschinski; Ghaleb A. Almekhlafi; Marc Leone; Majid Mokhtari; Luis E. Fontes; Philippe Bauer; Yasser Sakr; ICON investigators; Andrew Bersten

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, Stephan M. Jakob, Ulrich Jaschinski, Ghaleb A. Almekhlafi, Marc Leone, Majid Mokhtari, Luis E. Fontes, Philippe Bauer, Yasser Sakr, ICON investigators, Andrew Bersten

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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
Number of pages	14
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

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Vincent_Clinical_P2020Final published version, 760 KBLicence: CC BY

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Vincent, J. L., Ferguson, A., Pickkers, P., Jakob, S. M., Jaschinski, U., Almekhlafi, G. A., Leone, M., Mokhtari, M., Fontes, L. E., Bauer, P., Sakr, Y., ICON investigators, & Bersten, A. (2020). The clinical relevance of oliguria in the critically ill patient: Analysis of a large observational database. Critical Care, 24(1), Article 171. https://doi.org/10.1186/s13054-020-02858-x

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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 Philippe Bauer 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 Mamuka Chkhaidze and Vakhtang Kaloiani and Laszlo Medve and Agnes Sarkany and Ildiko Kremer and Zsuzsa Marjanek and Peter Tamasi and Inga Krupnova and Indulis Vanags and Viesturs Liguts and Vidas Pilvinis and Saulius Vosylius and Gintautas Kekstas and Mindaugas Balciunas and Julia Kolbusz and Andrzej K{\"u}bler and Beata Mielczarek and Malgorzata Mikaszewska-Sokolewicz and Katarzyna Kotfis and Barbara Tamowicz and Wiktor Sulkowski and Piotr Smuszkiewicz and Andrzej Pihowicz and Ewa Trejnowska and Natalia Hagau and Daniela Filipescu and Gabriela Droc and Lupu, {Mary Nicoleta} and Alexandru Nica and Radu Stoica and Tomescu, {Dana Rodica} and Constantinescu, {Dacia Laurentia} and {Valcoreanu Zbaganu}, {Georgica M.} and Adriana Slavcovici and Vladmir Bagin and Dmitry Belsky and Shamil Palyutin and Sergey Shlyapnikov and D. Bikkulova and Alexey Gritsan and Gulyaeva Natalia and Evgeny Makarenko and Vladimir Kokhno and Alla Tolkach and Evgeny Kokarev and Boris Belotserkovskiy and Konstantin Zolotukhin and Vladimir Kulabukhov and Ljiljana Soskic and Ivan Palibrk and Radmilo Jankovic and Bojan Jovanovic and Milena Pandurovic and Vesna Bumbasirevic and Boris Uljarevic and Maja Surbatovic and Nebojsa Ladjevic and Garri Slobodianiuk and Viliam Sobona and Andrea Cikova and Andrea Gebhardtova and Cao Jun and Sun Yunbo and Jun Dong and Sui Feng and Meili Duan and Yuan Xu and Xiaoyan Xue and Tieying Gao and Xing, {Xue Zhong} and Xin Zhao and Li, {Chao Hong} and Gengxihua Gengxihua and Huiqiong Tan and Jingqing Xu and Li Jiang and Qin Tiehe and Qin Bingyu and Qindong Shi and Zheng Lv and Liping Zhang and Liu Jingtao and Zheng Zhen and Zheng Wang and Wang, {Tie Hua} and Liu Yuhong and Qian Zhai and Ying Chen and Chunting Wang and Wei Jiang and Wang Ruilan and Youdai Chen and Huang Xiaobo and Huiqing Ge and Tang Yan and Cui Yuhui and Jiuzhi Zhang and Fu Jian-Hong and Hong Zhu and Feifei Huo and Yushan Wang and Chao Li and Ma Zhuang and Zengxiang Ma and Jian Sun and Liuqingyue Liuqingyue and Mingshi Yang and Jianbiao Meng and Shaolin Ma and Yan Kang and Li Yu and Qianyi Peng and Yu Wei and Wei Zhang and Renhua Sun and Alwin Yeung and Wan, {Wing Lun} and Sin, {K. Kai Cheuk} and Lee, {Kar Lung} and Meri Wijanti and Untung Widodo and Halim Samsirun and Tantani Sugiman and Calcarina Wisudarti and Maskoen, {Tinni T.} and Noritaka Hata and Yoshiro Kobe and Osamu Nishida and Dai Miyazaki and Shin Nunomiya and Shigehiko Uchino and Nobuya Kitamura and Koichi Yamashita and Satoru Hashimoto and Hidetada Fukushima and Adib, {Nik Azman Nik} and Tai, {Li Ling} and Bill Tony and Bigornia, {Rodolfo Roman} and Palo, {Jose Emmanuel} and Somnath Chatterjee and Tan, {Bee Hong} and Andrew Kong and Shirley Goh and Lee, {Chien Chang} and Chaicharn Pothirat and Bodin Khwannimit and Pongdhep Theerawit and Prapaporn Pornsuriyasak and Annop Piriyapatsom and Ahmed Mukhtar and Hamdy, {Ahmed Nabil} and Hisham Hosny and Ali Ashraf and Shiva Nowruzinia and Lotfi, {Amir Hossein} and Farid Zand and Reza Nikandish and Moghaddam, {Omid Moradi} and Jonathan Cohen and Oded Sold and Tacla Sfeir and Hasan, {Alaa Yasin} and Dena Abugaber and Habib Ahmad and Tarek Tantawy and Salim Baharoom and Haifa Algethamy and Anas Amr and Ramazan Coskun and Murat Sungur and Ahmet Cosar and B{\"u}lent G{\"u}{\c c}yetmez and Oktay Demirkiran and Evren Senturk and Hulya Ulusoy and Atalan, {Hakan Korkut} and Simay Serin and Ismail Kati and Zainab Alnassrawi and Ayesha Almemari and Kalpana Krishnareddy and Sayed Kashef and Asad Alsabbah and Germain Poirier and Marshall, {John C.} and Margaret Herridge and Rosangela Fernandez-Medero and Gerard Fulda and Sharon Banschbach and Juan Quintero and Elizabeth Schroeder and Corinna Sicoutris and Renaud Gueret and Rahul Kashyap and Rahul Nanchal and Wunderink, {Richard G.} and Andrew Bersten",

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

AU - Sakr, Yasser

AU - ICON investigators

AU - Tomas, Esmael

AU - Bibonge, Eric Amisi

AU - Charra, Boubaker

AU - Faroudy, Mamoun

AU - Doedens, Linda

AU - Farina, Zane

AU - Adler, David

AU - Balkema, Cecile

AU - Kok, Adri

AU - Alaya, Sami

AU - Gharsallah, Hedi

AU - Muzha, Dritan

AU - Temelkov, Atanas

AU - Georgiev, Georgi

AU - Simeonov, Georgi

AU - Tsaryanski, Georgi

AU - Georgiev, Silvi

AU - Seliman, Ali

AU - Vrankovic, Srdan

AU - Vucicevic, Zeljko

AU - Gornik, Ivan

AU - Barsic, Bruno

AU - Husedzinovic, Ino

AU - Pavlik, Pavel

AU - Manak, Jan

AU - Kieslichova, Eva

AU - Turek, Radovan

AU - Fischer, Michal

AU - Valkova, Radka

AU - Dadak, Lukas

AU - Dostal, Pavel

AU - Malaska, Jan

AU - Hajek, Roman

AU - Židková, Alexandra

AU - Lavicka, Pavel

AU - Starkopf, Joel

AU - Kheladze, Zurab

AU - Chkhaidze, Mamuka

AU - Kaloiani, Vakhtang

AU - Medve, Laszlo

AU - Sarkany, Agnes

AU - Kremer, Ildiko

AU - Marjanek, Zsuzsa

AU - Tamasi, Peter

AU - Krupnova, Inga

AU - Vanags, Indulis

AU - Liguts, Viesturs

AU - Pilvinis, Vidas

AU - Vosylius, Saulius

AU - Kekstas, Gintautas

AU - Balciunas, Mindaugas

AU - Kolbusz, Julia

AU - Kübler, Andrzej

AU - Mielczarek, Beata

AU - Mikaszewska-Sokolewicz, Malgorzata

AU - Kotfis, Katarzyna

AU - Tamowicz, Barbara

AU - Sulkowski, Wiktor

AU - Smuszkiewicz, Piotr

AU - Pihowicz, Andrzej

AU - Trejnowska, Ewa

AU - Hagau, Natalia

AU - Filipescu, Daniela

AU - Droc, Gabriela

AU - Lupu, Mary Nicoleta

AU - Nica, Alexandru

AU - Stoica, Radu

AU - Tomescu, Dana Rodica

AU - Constantinescu, Dacia Laurentia

AU - Valcoreanu Zbaganu, Georgica M.

AU - Slavcovici, Adriana

AU - Bagin, Vladmir

AU - Belsky, Dmitry

AU - Palyutin, Shamil

AU - Shlyapnikov, Sergey

AU - Bikkulova, D.

AU - Gritsan, Alexey

AU - Natalia, Gulyaeva

AU - Makarenko, Evgeny

AU - Kokhno, Vladimir

AU - Tolkach, Alla

AU - Kokarev, Evgeny

AU - Belotserkovskiy, Boris

AU - Zolotukhin, Konstantin

AU - Kulabukhov, Vladimir

AU - Soskic, Ljiljana

AU - Palibrk, Ivan

AU - Jankovic, Radmilo

AU - Jovanovic, Bojan

AU - Pandurovic, Milena

AU - Bumbasirevic, Vesna

AU - Uljarevic, Boris

AU - Surbatovic, Maja

AU - Ladjevic, Nebojsa

AU - Slobodianiuk, Garri

AU - Sobona, Viliam

AU - Cikova, Andrea

AU - Gebhardtova, Andrea

AU - Jun, Cao

AU - Yunbo, Sun

AU - Dong, Jun

AU - Feng, Sui

AU - Duan, Meili

AU - Xu, Yuan

AU - Xue, Xiaoyan

AU - Gao, Tieying

AU - Xing, Xue Zhong

AU - Zhao, Xin

AU - Li, Chao Hong

AU - Gengxihua, Gengxihua

AU - Tan, Huiqiong

AU - Xu, Jingqing

AU - Jiang, Li

AU - Tiehe, Qin

AU - Bingyu, Qin

AU - Shi, Qindong

AU - Lv, Zheng

AU - Zhang, Liping

AU - Jingtao, Liu

AU - Zhen, Zheng

AU - Wang, Zheng

AU - Wang, Tie Hua

AU - Yuhong, Liu

AU - Zhai, Qian

AU - Chen, Ying

AU - Wang, Chunting

AU - Jiang, Wei

AU - Ruilan, Wang

AU - Chen, Youdai

AU - Xiaobo, Huang

AU - Ge, Huiqing

AU - Yan, Tang

AU - Yuhui, Cui

AU - Zhang, Jiuzhi

AU - Jian-Hong, Fu

AU - Zhu, Hong

AU - Huo, Feifei

AU - Wang, Yushan

AU - Li, Chao

AU - Zhuang, Ma

AU - Ma, Zengxiang

AU - Sun, Jian

AU - Liuqingyue, Liuqingyue

AU - Yang, Mingshi

AU - Meng, Jianbiao

AU - Ma, Shaolin

AU - Kang, Yan

AU - Yu, Li

AU - Peng, Qianyi

AU - Wei, Yu

AU - Zhang, Wei

AU - Sun, Renhua

AU - Yeung, Alwin

AU - Wan, Wing Lun

AU - Sin, K. Kai Cheuk

AU - Lee, Kar Lung

AU - Wijanti, Meri

AU - Widodo, Untung

AU - Samsirun, Halim

AU - Sugiman, Tantani

AU - Wisudarti, Calcarina

AU - Maskoen, Tinni T.

AU - Hata, Noritaka

AU - Kobe, Yoshiro

AU - Nishida, Osamu

AU - Miyazaki, Dai

AU - Nunomiya, Shin

AU - Uchino, Shigehiko

AU - Kitamura, Nobuya

AU - Yamashita, Koichi

AU - Hashimoto, Satoru

AU - Fukushima, Hidetada

AU - Adib, Nik Azman Nik

AU - Tai, Li Ling

AU - Tony, Bill

AU - Bigornia, Rodolfo Roman

AU - Palo, Jose Emmanuel

AU - Chatterjee, Somnath

AU - Tan, Bee Hong

AU - Kong, Andrew

AU - Goh, Shirley

AU - Lee, Chien Chang

AU - Pothirat, Chaicharn

AU - Khwannimit, Bodin

AU - Theerawit, Pongdhep

AU - Pornsuriyasak, Prapaporn

AU - Piriyapatsom, Annop

AU - Mukhtar, Ahmed

AU - Hamdy, Ahmed Nabil

AU - Hosny, Hisham

AU - Ashraf, Ali

AU - Nowruzinia, Shiva

AU - Lotfi, Amir Hossein

AU - Zand, Farid

AU - Nikandish, Reza

AU - Moghaddam, Omid Moradi

AU - Cohen, Jonathan

AU - Sold, Oded

AU - Sfeir, Tacla

AU - Hasan, Alaa Yasin

AU - Abugaber, Dena

AU - Ahmad, Habib

AU - Tantawy, Tarek

AU - Baharoom, Salim

AU - Algethamy, Haifa

AU - Amr, Anas

AU - Coskun, Ramazan

AU - Sungur, Murat

AU - Cosar, Ahmet

AU - Güçyetmez, Bülent

AU - Demirkiran, Oktay

AU - Senturk, Evren

AU - Ulusoy, Hulya

AU - Atalan, Hakan Korkut

AU - Serin, Simay

AU - Kati, Ismail

AU - Alnassrawi, Zainab

AU - Almemari, Ayesha

AU - Krishnareddy, Kalpana

AU - Kashef, Sayed

AU - Alsabbah, Asad

AU - Poirier, Germain

AU - Marshall, John C.

AU - Herridge, Margaret

AU - Fernandez-Medero, Rosangela

AU - Fulda, Gerard

AU - Banschbach, Sharon

AU - Quintero, Juan

AU - Schroeder, Elizabeth

AU - Sicoutris, Corinna

AU - Gueret, Renaud

AU - Kashyap, Rahul

AU - Nanchal, Rahul

AU - Wunderink, Richard G.

AU - Bersten, Andrew

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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