![]() ![]() However, the interpretation of oliguria remains a daily challenge for clinicians throughout the world who struggle to differentiate a physiological adaptation to stress from kidney damage. Low UO (oliguria) is associated with 90-day mortality irrespective of changes in serum creatinine (sCr). ![]() It is a major component of acute kidney injury (AKI) diagnosis and staging. Urinary output (UO) is the most obvious and accessible window to renal function in the intensive care unit (ICU). A cut-off of 0.2 ml/kg/h over 3 or 6 h is supported by the data and should be considered in further definitions of oliguria. The widely used cut-off for oliguria of 0.5 ml/kg/h over 6 h may be too conservative. Contrary to consensus definition, this threshold identified a population with a higher predicted 90-day mortality. Considering a threshold of < 0.2 ml/kg/h over 6 h, the proportion of patients with an episode of oliguria decreased substantially to 24.7% (95% CI ). The relationship between minimum average UO and predicted 90-day mortality was nonlinear with an inflexion point at 0.2 ml/kg/h for 3 and 6 h windows and 0.3 ml/kg/h for 12 and 24 h windows. We tested models’ discrimination and calibration on the entire validation set as well as on a subset of patients with oliguria according to proposed thresholds.Īmong the 15,500 patients included in this analysis (training set: 12,440, validation set: 3110), 73.0% (95% CI ) presented an episode of oliguria as defined by consensus criteria (UO 85% for all time windows) discrimination and calibration. Optimal thresholds were determined by visually identifying cut-off values for the minimum average UO below which predicted mortality increased substantially. In the training set, we developed multivariable models to assess the relationship between 90-day mortality and the minimum average UO calculated over time windows of 3, 6, 12 and 24 h. We randomly split our data into a training (80%) and a validation (20%) set. We extracted hourly urinary output (UO) measurements along with patient’s characteristics from electronic medical records and 90-day mortality from the Swiss national death registry. Patients on chronic dialysis or who declined consent were excluded. MethodsĬohort study including adult patients admitted within a multi-disciplinary intensive care unit between January 1st 2010 and June 15th 2020. We aimed to determine the optimal threshold to define oliguria in critically-ill patients. The relevance of current consensus threshold to define oliguria has been challenged by small observational studies. ![]()
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