The significance of microalbuminuria in critical illness

Microalbuminuria seems to reflect the function of the glomerular and systemic endothelium and it could be used to monitor the endothelial function in critically ill patients with signs of a systemic inflammatory response. The aim of the present article is to review the significance of microalbuminuria separately in surgical, trauma, cardiac and medical intensive care unit (ICU) patients. In surgical ICU patients microalbuminuria persisting for more than 6-24 h seems to correlate with postoperative septic complications and with ICU mortality, even if with a low positive predictive value. In trauma ICU patients, microalbuminuria levels 6-24 h after trauma correlate with severity of illness, ICU mortality and ICU stay, whereas microalbuminuria levels in the first 6-24 h after trauma is more correlated just to the entity of trauma. In cardiac patients with acute miocardial infarction, microalbuminuria is correlated both with hospital mortality and at least 3 yr outcome. In medical ICU patients microalbuminuria 4-6 h after ICU admission is a strong predictor of ICU mortality and severity of illness. This review suggests that, in ICU patients, microalbuminuria could integrate clinical severity scores to monitor the systemic inflammatory response and to predict severity of illness and mortality. © 2007.