Work

Evaluation of 6-hour urine creatinine clearance as the kidney component in the SOFA score: An observational cohort study

Year: 2025

Type: article

Abstract: The Sequential Organ Failure Assessment (SOFA) score, originally designed to reflect disease severity, has since been found to be a prognostic tool for critically ill patients. Recently, a call was made for an update to the score to reflect the changes in clinical practice that have occurred since its original publication. This was a single-center, prospective, observational study conducted in a mixed intensive care unit (ICU) of a university-affiliated tertiary hospital from September 10, 2023, until January 7, 2025. Urinary creatinine clearance (CrCl) was calculated daily based on a daily 6-h urine collection performed during the first five nights of admission. Patients were then assigned to five groups (0–4) according to CrCl and Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease definitions, and a modified SOFA score was calculated based on these groupings. The predictive ability of serum creatinine (Scr), urine output, urinary CrCl, the original SOFA score, and the modified SOFA score for ICU and 90-day mortality was compared by evaluating their area under the receiver operating characteristic (AUROC) values. A total of 200 patients were included in the study. The ICU mortality for these patients was 12.0 % while the 90-day mortality reached 29.5 %. Compared with Scr, urinary CrCl displayed significantly higher AUROC values for mortality prediction on almost all days examined. For example, on day 3, the AUROC values were 0.821 vs. 0.730 ( P =0.003) for ICU mortality, and 0.760 vs. 0.660 ( P =0.002) for 90-day mortality. Similarly, the modified SOFA score showed significantly higher AUROC values for mortality prediction on most days assessed. On day 3, the AUROC values were 0.791 vs. 0.706 ( P =0.046) for ICU mortality, and 0.741 vs. 0.655 ( P =0.007) for 90-day mortality. The categorization of urinary CrCl based on a 6-h urine collection can improve the ability of the SOFA score for predicting mortality. Trial Registration: Clinicaltrials.gov Identifier: NCT06779331

Source: Journal of Intensive Medicine

DOI: 10.1016/j.jointm.2025.08.009