A high urea-to-creatinine ratio predicts long-term mortality independent of acute kidney injury among patients hospitalized with an infection

Sci Rep. 2020 Sep 24;10(1):15649. doi: 10.1038/s41598-020-72815-9.

Abstract

Acute kidney injury (AKI) occurs frequently in patients with sepsis. Persistent AKI is, in contrast to transient AKI, associated with reduced long-term survival after sepsis, while the effect of AKI on survival after non-septic infections remains unknown. As prerenal azotaemia is a common cause of transient AKI that might be identified by an increased urea-to-creatinine ratio, we hypothesized that the urea-to-creatinine ratio may predict the course of AKI with relevance to long-term mortality risk. We studied the association between the urea-to-creatinine ratio, AKI and long-term mortality among 665 patients presented with an infection to the ED with known pre-existent renal function. Long-term survival was reduced in patients with persistent AKI. The urea-to-creatinine ratio was not associated with the incidence of either transient or non-recovered AKI. In contrast, stratification according to the urea-to-creatinine-ratio identifies a group of patients with a similar long-term mortality risk as patients with persistent AKI. Non-recovered AKI is strongly associated with all-cause long-term mortality after hospitalization for an infection. The urea-to-creatinine ratio should not be employed to predict prerenal azotaemia, but identifies a group of patients that is at increased risk for long-term mortality after infections, independent of AKI and sepsis.

MeSH terms

  • Acute Kidney Injury / complications*
  • Acute Kidney Injury / therapy*
  • Aged
  • Creatinine / blood*
  • Emergency Service, Hospital
  • Female
  • Hospitalization*
  • Humans
  • Infections / blood*
  • Infections / complications
  • Infections / diagnosis
  • Infections / mortality*
  • Male
  • Prognosis
  • Risk Factors
  • Urea / blood*

Substances

  • Urea
  • Creatinine