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

Sciprofile linkJean-Louis Vincent, for the ICON Investigators, Andrew Ferguson, Peter Pickkers, Stephan M. Jakob, Ulrich Jaschinski, Ghaleb A. Almekhlafi, Marc Leone, Majid Mokhtari, Luis E. Fontes, Philippe R. Bauer, Yasser Sakr, Esmael Tomas
Published: 23 April 2020
Critical Care , Volume 24, pp 1-14; doi:10.1186/s13054-020-02858-x

Abstract: 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. 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. 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&mdash;oliguria resolved within 48 h after the admission day (n = 390 [28.9%]), prolonged&mdash;oliguria resolved > 48 h after the admission day (n = 141 [10.5%]), and permanent&mdash;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&ndash;1.91], p = 0.001), but the presence of oliguria on admission was not (OR = 1.14 [95% CI 0.97&ndash;1.34], p = 0.103). 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

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