Hepatic and Renal Biochemical Markers as Predictors of Mortality Among Critically Ill Systemic Inflammatory Response...

Systemic inflammatory response syndrome (SIRS) is a frequently encountered complication seen in intensive care unit patients and remains a common cause of mortality. Assessing prognosis of those becomes a priority and indeed we have various efficient scoring systems for the same. However they use enormous data and involve complex calculations for scoring. We intended to find a simple, inexpensive, accurate diagnostic tool of certain markers to predict mortality outcome among critically ill SIRS patients and to evaluate their efficiency in comparison to Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. Eighty-seven patients were selected and general hepatic, renal and urinary investigations were done for them at 24 h of admission and were followed up for a period of 4 weeks from admission date to classify them as survivors and non-survivors. Twenty-one percent patients had succumbed to death during study period. Urine albumin-creatinine ratio, alanineaminotransferase, aspartate aminotransferase and prothrombin time/International Normalized Ratio were found to be correlating with APACHE II scores and mortality significantly. Specific individual cut-offs were found for these parameters and were combined to form combined predictors which showed good discrimination (AUC = 0.715) and good calibration (p = 0.811) with specificity of 98.6% in predicting mortality. SIRS patients falling above combined predictor's cutoff are 54 times more likely to have an unfavorable outcome compared to the ones below. Overall predictive accuracy of first day combined predictors was such that within 24 h of ICU admission 87% of ICU SIRS admissions could be given a risk estimate for hospital death.