الفهرس 
SepsisOnly 14 pages are availabe for public view
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Abstract
SUMMARY
S
epsis remains a major global healthcare concern, owing to high morbidity and mortality, despite the advances in medical therapeutics. Targeted therapies probably lose their efficacy due to late administration. Early administration of intensive therapy to critically ill patients has shown promise in improving mortality. An early event is the loss of barrier integrity leading to systemic capillary leak which is manifested as increased excretion of albumin in the urine. Microalbuminuria, defined as 30–300 mg/day of albumin excretion in the urine is a common finding in critically ill patients, where it has shown promise not only as a predictor of organ failure and vasopressor requirement but of mortality, faring better than SOFA and APACHE II score.
This study was conducted in critical care department to evaluate the degree of microalbuminuria (ACR) in sepsis patients and whether it could predict mortality in critically ill sepsis patients and early detection of acute kidney injury, also to evaluate the relationship between microalbuminuria and SOFA &APACHE II score. Patients presenting with features of sepsis and suspected infection were included in the study and after exclusion, a total of 40 patients were included in the study. Urine sample for ACR (Albumin and Creatinine Ratio) was done at ICU admission (ACR1) and at 24 hours (ACR2) of admission and APACHI II &SOFA calculated.
The following ICU outcome measures were recorded for all patients: (Duration of stay in the ICU, need for mechanical ventilation, need for inotropic/vasopressor support, need for haemodialysis, and final outcome of mortality rates).
Total 40 patients were included in the study; the mean age of the survived group was (37.17 ± 7.349) years that was statistically significant lower as compared with the non-survived group (50.36 ± 7.393) years (p < 0.001). there was no statistically significant difference in the sex distribution between the cases in the two groups.
The mean APACHE score in the non-survived group was (22.45 ± 3.205) that was statistically significant higher as compared with the survived group (15.31 ± 6.130) (p= 0.001).
The mean SOFA score on admission in the non-survived group was (9.27 ± 4.101) that was statistically significant higher as compared with the survived group (3.38 ± 3.580) (p < 0.001). the highest SOFA score in the non-survived group was (13.91 ± 5.147) that was statistically significant higher as compared with the survived group (4.38 ± 3.669) (p < 0.001).
The mean ACR on admission in the non-survived group was (168.86 ± 51.722) mg/g that was statistically significant higher as compared with the survived group (105.00 ± 56.616) mg/g (p= 0.002). the mean ACR after 24 hours of admission in the non-survived group was (174.51 ± 57.566) mg/g that was statistically significant higher as compared with the survived group (104.37 ± 57.759) mg/g (p= 0.001).
Out of 40 patients were included in the study The percentage of cases who required mechanical ventilation in the non-survived group was (90.9%) that was statistically significant higher as compared with the survived group (21.4%) (p < 0.001).
Out of40 patients were included in the study The percentage of cases who required inotropes in the non-survived group was (90.9%) that was statistically significant higher as compared with the survived group (37.9%) (p < 0.001).
There was no statistically significant difference in the percentage of cases who required RRT in both groups although the percentage was higher in the non-survived group.
Receiver operator characteristic (ROC) curve was calculated for the use of ACR concentration as a predictor of ICU mortality.the best cutoff point of ACR to predict mortality was (147.2) with (81.8%) sensitivity, (82.8%) specificity, (64.3%) PPV and (92.3%) NPV and (82.5%) accuracy. the best cutoff point of SOFA score to predict mortality was (3.5) with (90.9%) sensitivity, (72.4%) specificity, (55.6%) PPV and (95.5%) NPV and (77.5%) accuracy. the best cutoff point of APACHE II to predict mortality was (22.5) with (81.8%) sensitivity, (86.2%) specificity, (69.2%) PPV and (92.6%) NPV and (85%) accuracy.