Publication:

Microalbuminuria as an indicator of sepsis and to predict mortality in patients admitted in intensive care unit

Background Sepsis remains a major cause of morbidity and mortality worldwide. Early recognition is critical, but conventional diagnostic methods such as culture require more than 24 hours, delaying targeted therapy. Microalbuminuria, a marker of systemic endothelial dysfunction and capillary leak, may provide a rapid and non-invasive predictor of outcome. Objective of this study was to assess the role of microalbuminuria in predicting mortality among patients with sepsis admitted to the intensive care unit (ICU).

Methods This prospective observational study was conducted in the ICU of Travancore Medical College, Kollam, from August 2022 to January 2024. A total of 122 adult patients with sepsis were enrolled after applying inclusion and exclusion criteria. Spot urine samples were collected within 6 hours of admission (ACR1) and at 24 hours (ACR2) to measure the albumin–creatinine ratio (ACR). The change in ACR (ΔACR = ACR1-ACR2) was calculated. Associations of ACR values with mortality and ICU stay were analysed using non-parametric tests, correlation studies, and ROC curve analysis.

Results ACR2 was significantly higher among non-survivors than survivors (mean 284.3 vs. 77.0, p<0.001). Survivors showed a significant decline in ACR between 6 and 24 hours, while non-survivors had a significant increase. ΔACR correlated negatively with ICU stay duration (ρ = -0.303, p<0.001). ROC analysis identified ΔACR ≤21.5 as the optimal cutoff for predicting mortality, with sensitivity 83.9%, specificity 86.9%, and accuracy 86.2%.

Conclusions Serial measurement of urine ACR, particularly ΔACR, within the first 24 hours is a simple, rapid, and cost-effective predictor of mortality in sepsis and can be especially valuable in resource-limited settings.