Prevalence and prediction of augmented renal clearance in the neurocritical care population

Abstract

Background Augmented renal clearance (ARC; creatinine clearance [CrCl] >130 mL/min/1.73 m2) is prevalent in patients with neurological injuries and may influence their exposure to important pharmacological therapies. Little is known about the relationship between estimated and measured CrCl in this population. Methods This single-center, prospective, observational cohort study aimed to describe the association between ARC and estimated CrCl and neurological outcomes in a broad neurocritical care population. Prospective patient screening criteria included adults aged 18–85 years, with critical illness due to neurologic causes (such as ischemic stroke or subarachnoid hemorrhage) and lack of renal dysfunction on admission. Patients who had at least one urine CrCl measurement performed within the first 7 days of hospitalization were included. Two cohorts were evaluated: those with ARC and those without ARC. Results Fifty-seven patients were included, of whom 49 (86%) exhibited ARC. Subjects with ARC were more likely to be male and had a significantly higher median measured CrCl (201.7 mL/min/1.73 m2) than those without ARC (109.8 mL/min/1.73 m2). The Augmented Renal Clearance in Trauma Intensive Care (ARCTIC) score displayed the strongest association (vs. CrCl equations) with ARC development (area under the receiver operating characteristic curve, 0.648). Conclusion The prevalence of ARC in the present study of a broad neurocritical care population appeared to be high (86%). The ARCTIC score had higher sensitivity and specificity for diagnosing ARC than the common serum creatinine-based estimation.

Keywords

• stroke
• aneurysmal subarachnoid hemorrhage
• pharmacokinetics
• traumatic brain injury