Urine output for predicting in-hospital mortality of intensive care patients with cardiogenic shock

Tianyang Hu; Rongzhong Huang

doi:10.1016/j.heliyon.2023.e16295

Urine output for predicting in-hospital mortality of intensive care patients with cardiogenic shock

Heliyon. 2023 May 25;9(6):e16295. doi: 10.1016/j.heliyon.2023.e16295. eCollection 2023 Jun.

Authors

Tianyang Hu¹, Rongzhong Huang^{1

2}

Affiliations

¹ Precision Medicine Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
² Chongqing Municipality Clinical Research Center for Geriatrics and Gerontology, Chongqing, China.

Abstract

Background: The role of urine output (UO) in the first 24 h of admission in the clinical management of cardiogenic shock (CS) patients has not been elucidated.

Methods: This study retrospectively analyzed intensive care CS patients in the MIMIC-IV database. Binomial logistic regression analysis was conducted to evaluate whether UO was an independent risk factor for in-hospital mortality in CS patients. The performance of UO in predicting mortality was evaluated by the receiver operating characteristic (ROC) curve and compared with the Oxford Acute Severity of Illness Score (OASIS). The clinical net benefit of UO in predicting mortality was determined using the decision curve analysis (DCA). Survival analysis was performed with Kaplan-Meier curves.

Results: After adjusting for confounding factors including diuretic use and acute kidney injury (AKI), UO remained an independent risk factor for in-hospital mortality in CS patients. The areas under the ROC curves (AUCs) of UO for predicting in-hospital mortality were 0.712 (UO, ml/day) and 0.701 (UO, ml/kg/h), which were comparable to OASIS (AUC = 0.695). In terms of clinical net benefit, UO was comparable to OASIS, with different degrees of benefit at different threshold probabilities. Survival analysis showed that the risk of in-hospital death in the low-UO (≤857 ml/day) group was 3.0143 times that of the high-UO (>857 ml/day) group.

Conclusions: UO in the first 24 h of admission is an independent risk factor for in-hospital mortality in intensive care CS patients and has moderate predictive value in predicting in-hospital mortality.

Keywords: Cardiogenic shock; In-hospital mortality; MIMIC-IV; Oxford acute severity of illness score; Urine output.