Acute and Critical Care

Original Articles

Surgery
Failure of early creatinine recovery predicts poor survival after emergency surgery for bowel perforation or infarction: Hyun Il Kim, Min Hong Lee, Byung Jun Jeon, Yoon Mo Kim, Mi Kyung Oh, Min Gyu Kim; Acute Crit Care. 2026;41(1):126-135. Published online February 27, 2026; DOI: https://doi.org/10.4266/acc.003625

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Abstract PDF: Background
Early postoperative recovery of kidney function is critical in emergency bowel surgery. This study evaluated the prognostic value of preoperative creatinine elevation (PCE) and early creatinine recovery (ECR). Methods: A total of 424 patients underwent emergency surgery for bowel perforation or ischemia from January 2019 to December 2024. Sixteen trauma-related cases (including procedure-related injuries) were excluded, leaving 408 patients for analysis. Of these, 35 patients with end-stage renal disease or chronic kidney disease—either pre-existing or newly diagnosed during hospitalization—were excluded. ECR was defined as a decrease in serum creatinine to <1.3 mg/dl by postoperative day (POD) 3. PCE was defined as serum creatinine >1.3 mg/dl. Associations with postoperative complications and 30-day mortality were estimated using multivariable logistic regression and reported as adjusted odds ratios (aORs) with 95% CIs. Results: PCE occurred in 18.5% (69/373) of the tested patients; among these, 58.0% (40/69) achieved ECR by POD 3. Failure of ECR was associated with severe complications (93.1% vs. 27.5%, P<0.001) and higher mortality (72.4% vs. 7.5%, P<0.001). In multivariable analysis, ECR failure independently predicted complications (aOR, 28.71; 95% CI, 5.44–151.57) and 30-day mortality (aOR, 32.37; 95% CI, 7.74–135.40; P<0.001 for both), Conclusions: Failure to achieve ECR is independently associated with poor survival after emergency laparotomy for peritonitis. This finding supports the use of a creatinine-based checkpoint to trigger intensified monitoring and targeted rescue interventions.

Trauma
Effect of atorvastatin as a renal protective agent in patients with systemic inflammatory response syndrome using the renal arterial resistive index: Mina Maher Raouf, Eslam Antar Shadad, Nagy Sayed Ali; Acute Crit Care. 2025;40(1):95-104. Published online February 18, 2025; DOI: https://doi.org/10.4266/acc.003912

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Background
Current meta-analyses have yielded inconclusive results regarding the effectiveness of statins in preventing early renal injury in the context of poly-trauma. Notably, renal artery Doppler-derived resistance indices have shown a strong correlation with early detection of renal impairment, underscoring their importance in clinical assessment.
Methods
The study involved 106 adults aged 18 years and older of both sexes, who presented to Minia University Hospital, Egypt, with poly-trauma with a two-point or greater increase in the sequential organ failure assessment score within the first 72 hours of hospital admission and who met two or more of the diagnostic criteria of systemic inflammatory response syndrome. Participants were randomly assigned to either the atorvastatin group, which received oral atorvastatin at a dosage of 20 mg every 12 hours for 1 week alongside conventional therapy (antimicrobial agents and balanced crystalloids), or the control group, which received conventional therapy along with a placebo tablet every 12 hours for 1 week.
Results
The atorvastatin group yielded a significantly lower incidence of acute kidney injury (AKI; P<0.001). Additionally, there was significant reduction in renal resistance and pulsatility indices in the atorvastatin group. Furthermore, the atorvastatin group exhibited a shorter intensive care unit (ICU) stay (P=0.004). The renal index had a sensitivity of 90% and specificity of 68% for AKI prediction when the cutoff value was 0.61. Pulsatility index had a sensitivity of 90% and a specificity of 53% when the cutoff value was 1.28.
Conclusions
Atorvastatin was impactful in mitigating the incidence of AKI, improving renal resistive vascular indices, and abbreviating ICU stays in the poly-traumatized population.

Citations

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Association of different serum creatinine trajectories with 28-day mortality in patients with acute kidney injury on chronic kidney disease: based on the MIMIC-IV database
Jun Ying, Hanjing Zhou, Yingxin Zhang, Shan Zhu, Gancong Zhang, Jian Huang
European Journal of Medical Research.2025;[Epub] CrossRef

Trauma
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma: Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee; Acute Crit Care. 2023;38(1):95-103. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01046

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Abstract PDF: Background
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE).
Methods
We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs.
Results
The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage.
Conclusions
In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Nephrology
Measured versus estimated creatinine clearance in critically ill patients with acute kidney injury: an observational study: Sara Kadivarian, Fatemeh Heydarpour, Hasanali Karimpour, Foroud Shahbazi; Acute Crit Care. 2022;37(2):185-192. Published online April 22, 2022; DOI: https://doi.org/10.4266/acc.2021.01256

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Abstract PDF

Background
Acute kidney injury (AKI) commonly occurs in critically ill patients. Estimation of renal function and antibiotics dose adjustment in patients with AKI is a challenging issue.
Methods
Urinary creatinine clearance was measured in a 6-hour urine collection from patients with acute kidney injuries. The correlations between different formulas including the modified Cockcroft-Gault, modification of diet in renal disease, chronic kidney disease-epidemiology collaboration, Jelliffe, kinetic-glomerular filtration rate (GFR), Brater, and Chiou formulas were considered. The pattern of the prescribed antimicrobial agents was also compared with the patterns in the available resources.
Results
Ninety-five patients with acute kidney injuries were included in the research. The mean age of the participants was 63.11±17.58 years old. The most patients (77.89%) were in stage 1 of AKI according to the Acute Kidney Injury Network criteria, followed by stage 2 (14.73%) and stage 3 (7.36), respectively. None of the formulations had a high or very high correlation with the measured creatinine clearance. In stage 1, Chiou (r=0.26), and in stage 2 and 3, kinetic-GFR (r=0.76 and r=0.37) had the highest correlation coefficient. Antibiotic over- and under-dosing were frequently observed in the study.
Conclusions
The results showed that none of the static methods can predict the measured creatinine clearance in the critically ill patients. The dynamic methods such as kinetic-GFR can be helpful for patients who do not receive diuretics and vasopressors. Further studies are needed to confirm our results.

Citations

Citations to this article as recorded by

Evaluation of 6-hour urine creatinine clearance as the kidney component in the SOFA score: An observational cohort study
Liran Statlender, Tzippy Shochat, Mzia Moshiashvili, Eyal Robinson, Moran Hellerman Itzhaki, Itai Bendavid, Guy Fishman, Pierre Singer, Ilya Kagan
Journal of Intensive Medicine.2026; 6(1): 69. CrossRef
Association between phase angle and daily creatinine excretion changes in critically ill patients: an approach to muscle mass
Patricio Vargas-Errázuriz, Natalia Dreyse, René López, Marcelo Cano-Cappellacci, Jerónimo Graf, Julia Guerrero
Frontiers in Physiology.2025;[Epub] CrossRef
Clinical pharmacist-led problem-specific education as a strategy for addressing suboptimal antimicrobial use in intensive care unit: a prospective pre-post analysis
Enes Emir İlerler, Yunus Emre Ayhan, Erdem Yalçinkaya, Sait Karakurt, Mesut Sancar
Frontiers in Pharmacology.2025;[Epub] CrossRef
Beta-lactam dose reductions in critically ill patients with acute kidney injury: a scoping review
M. M.B. Horstink, W. J.R. Rietdijk, D. R. Geel, P. E. Deetman, H. Endeman, B. C.P. Koch, C. A. den Uil
Critical Care.2025;[Epub] CrossRef
SWOT and Root Cause Analyses of Antimicrobial Resistance to Oral Antimicrobial Treatment of Cystitis
Pradeep Tyagi, Shachi Tyagi, Laurence Stewart, Scott Glickman
Antibiotics.2024; 13(4): 328. CrossRef
Prospective Comparison of Urinary Measured Creatinine Clearance With eGFR and Cystatin C Based Cis-eGFR, Including Kinetic eGFR in the Immediate Post-transplant Period With Prompt Allograft Function
Ashokkumar Jain, Umar Farooq, Nasrollah Ghahramani, Deborah Daoud, Eileen Swartz, Christopher Hamilton, Alireza Vafaei Sadr, Thomas Butler
Transplantation Proceedings.2024; 56(6): 1319. CrossRef
Development and validation of a deep learning algorithm for the prediction of serum creatinine in critically ill patients
Ghodsieh Ghanbari, Jonathan Y Lam, Supreeth P Shashikumar, Linda Awdishu, Karandeep Singh, Atul Malhotra, Shamim Nemati, Zaid Yousif
JAMIA Open.2024;[Epub] CrossRef
Estimated glomerular filtration rates are higher when creatinine‐based equations are compared with a cystatin C‐based equation in coronavirus disease 2019
Anders O. Larsson, Michael Hultström, Robert Frithiof, Miklos Lipcsey, Ulf Nyman, Mats B. Eriksson
Acta Anaesthesiologica Scandinavica.2023; 67(2): 213. CrossRef
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma
Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee
Acute and Critical Care.2023; 38(1): 95. CrossRef

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