MICROALBUMINURIA AS A PROGNOSTIC VALUE FOR POST-OPERATIVE PATIENTS WITH RISK OF SEPSIS AFTER MAJOR ABDOMINAL SURGERY

Abstract

Background:- Microalbuminuria is one of the early indicators of sepsis. It is caused by diffused endothelial dysfunction in critically ill septic patients. The degree of microalbuminuria corresponds with the intensity of the inflammatory contempt.
Purpose:- To investigate whether microalbuminuria has a prognostic value in surgical sepsis or not, with particular regard to its role in anticipating illness intensity, clinical course and mortality.
Methods:- The study was applied in the critical care unit, Sayed Galal hospital, Faculty of medicine, Al-Azhar university. A sum of 80 patients were included in a prospective, non-interventional study following major abdominal surgery, and divided into two groups each group containing 40 patients. Albumin/Creatinine ratio (ACR, mg/g) was measured in urinary samples collected preoperatively (tp), upon ICU admission (t0), after 6 hours (t6) and at 24 hours (t24). Acute physiology and chronic health evaluation II (APACHE II) score was calculated 24, 48 and 72 hours, and Sequential Organ Failure assessment (SOFA) score was calculated daily for 3 days. Clinical outcome (length of ICU stay), and final outcome (survival or mortality rates) were recorded and documented for all patients.
Results:- There was statistically significant difference between groups according to ACR t0 to t24 specially at t6 which was highly significant in group II in relation to group I with p-value <0.001.There was highly statistically significant difference between groups according to APACHE score in group II in relation to group I for APACHE 24, 48, and 72, p-value <0.001. There was highly statistically significant difference between groups according to SOFA score in group II in relation to group I for SOFA1,2 and 3, p-value <0.001. There was statistically significant difference between groups according to outcome (death was 12.5% in group I in relation to 37.5% in group II) p-value 0.020.
Conclusion:- Microalbuminuria an easy, rapid and simple tool has a prognostic value in surgical sepsis, with precise regard to its role in anticipating illness severity, clinical course and mortality.
Key words:- Microalbuminuria; APACHE score; SOFA score; mortality; major abdominal surgery.