Creatinine and Mortality

In an epidemiologic study of 19,982 adults admitted to an urban academic medical center, Chertow et al. reported that increases in SCr of 0.3 to 0.4 mg/dl weresignificantly associated with in-hospital mortality (multivariable OR 1.7;95% CI, 1.2 to 2.6).

These individuals experienced a roughly 70% increase in the risk of death compared with patients withlittle or no change in SCr.

Note that the significance of a change of 0.3 mg/dL depends on the baseline Cr. For a given change in creatinine, the change in creatinine reflects a greater change in GFR at lower Cr levels compared with higher levels, i.e. early changes in Cr are more signficant. For example, an increase in Cr from 1 to 1.5 roughly correlates with a 33% drop in GFR. An increase in Cr from 4 to 4.5 roughly correlates with a 5% drop in GFR.

The gross relationship is GFR ≈ 1/Cr.

Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J. Am. Soc. Nephrol. 2005;16(11):3365-3370. Available at: http://www.ncbi.nlm.nih.gov.ezp-prod1.hul.harvard.edu/pubmed/16177006 [Accessed August 4, 2010].

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