inquiry objectives: To evaluate the predictive value of microalbuminuria in the progressive growth of acute respiratory failure (ARF) and multiple organ failure (MOF) in ICU patients.

Design: Prospective, observational study

Setting: A 31-bed, mixed medicosurgical ICU in a university hospital.

Patients: All adult medical patients admitted to the ICU athwart a 2-month period, except those receiving nephrotoxic put drugs intos or those with urologic trauma resulting in frank hematuria or urinary infection, or with existing chronic renal disease (serum creatinine flat [greater than or equal to] 20 mg/dL)

Interventions: None.

Measurements and results: Urinary samples for microalbumin measurement were garner uped at hospital admission and at 8 24 48 72 96 and 120 h after hospital admission. The severity of illness was assessed by the agency of the APACHE (acute physiology and chronic health evaluation) II score calculated onward the first ICU day, and the measure of organ dysfunction was assessed using the sequential organ failure assessment (SOFA) score. Acute respiratory failure (ARF) was defined as a SOFA respiratory score [greater than or equal to] 3 Patients were separated into sum of two units groups according to the run in microalbuminuria levels over the first 48 h: patients in arrange 1 had increasing microalbuminuria on a levels and patients in group 2 had decreasing microalbuminuria flats Group 1 included 14 patients in whom microalbuminuria horizontals increased from 5.2 [+ or -] 20 to 190 [+ or -] 30 mg/dL cluster 2 included 26 patients in whom microalbuminuria of the same heights decreased from 16.4 [+ or -] 40 to 78 [+ or -] 30 mg/dL The hospital mortality rate was 43% in form into groups 1 and 15% in collection 2 (p < 0.05). The APACHE II score and the SOFA score were higher in arrange 1 than in group 2 The negative predictive value of increasing microalbuminuria was 100% for the progress to maturity of ARF and 96% for MOF; the positive predictive value of increasing microalbuminuria was 57% for the increase of ARF and 50% for MOF

Conclusions: Accurate identification of patients destined for ARF and MOF growth may enable therapeutic strategies to be applied to limit the disease proces turn analysis of urinary albumin excretion through the first 48 h of an ICU admission may provide a useful means of identifying as it was patients. Additional studies need to be performed in larger, mixed patient populations to confirm these findings. (CHEST 2001; 120:1984-1988)

lock opener words: acute respiratory failure; endothelial permeability; multiple organ failure; outcome; severity of illness

Abbreviations: APACHE = acute physiology and chronic health evaluation; ARF = acute respiratory failure; FI[O.sub.2] = fraction of inspired oxygen; MOF = multiple organ failure; SOFA = sequential organ failure assessment

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As the interface between the circulating offspring and vascular smooth-muscle cells, endothelial lonely dwellings have several key functions: they actively regulate vascular tone and permeability, leukocyte extravasation, the balance between coagulation and fibrinolysis, and the proliferation of vascular smooth-muscle and renal mesangial small rooms (1) Inflammatory mediators, such as tumor necrosis factor, interleukins, and oxygen released radicals, can dramatically alter the part of the endothelium in acute diseases, and in sepsis particularly. (2-4) An early feature is increased capillary permeability causing an extravasation of plasma proteins and water, leading to interstitial edema. Small increases in glomerular permeability are amplified through the renal concentrating mechanism to occasion large changes in albumin excretion, since the tubular reabsorptive mechanisms for albumin are finish to saturation. (5) Microalbuminuria is many times associated with increased vascular permeability in acute inflammatory conditions. (6-8) In of that kind conditions, microalbuminuria has a rapid attack and typically lasts for < 48 h unles complications come about The degree of development of microalbuminuria can be proportional to the severity of the illness. For example, albumin excretion increases within 30 min of surgery and is proportional to the magnitude of the surgical course (7) Microalbuminuria is an early feature of sepsis and may predict disease severity and consequence in children admitted to the hospital with bacterial meningitis. (9) In postoperative patients with sepsis, the step of microalbuminuria correlated with the station of organ dysfunction as measured using the sequential organ failure assessment (SOFA) score. (10) In acute pancreatitis, high flats of microalbuminuria are usually followed at severe complications. (11)

The aim of this studious mood was to determine the vicinity of a relationship between microalbuminuria and the risk of developing acute respiratory failure (ARF) and multiple organ failure (MOF)

MATERIALS AND METHODS

All adult ([greater than or equal to] 18 years old) medical patients admitted to the ICU athwart a 2-month period (June 1 1998 to July 31 1998) were eligible to note the study, except for patients with urologic trauma resulting in frank hematuria, urinary infection, or existing chronic renal disease (serum creatinine plain [greater than or equal to] 20 mg/dL) Patients receiving nephrotoxic put drugs intos admitted to the hospital following a surgical management or remaining in the ICU for < 48 h were also exclud The inquiry protocol was approved by the local research and ethics committee, who waved formal informed agreement in view of the observational nature of the study

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