Urea-to-Creatinine Ratio as a Marker of Metabolic Transition in Septic Shock: A Comparison With Indirect Calorimetry
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 40
- 主要终点
- Urea-to-creatinine ratio and energy expenditure measured by indirect calorimetry
研究概览
简要总结
Urea-to-Creatinine Ratio as a Marker of Metabolic Transition in Septic Shock: A Comparison with Indirect Calorimetry.
This study investigates whether the urea-to-creatinine ratio can serve as a simple marker of metabolic state in patients with septic shock. Septic shock is associated with hypermetabolism and severe protein catabolism, which worsen outcomes. Although indirect calorimetry is the gold standard for measuring energy expenditure and metabolic demand in critically ill patients, its availability in ICUs is limited.
The authors hypothesize that the urea-to-creatinine ratio reflects protein catabolism and correlates with energy expenditure measured by indirect calorimetry, making it a potential tool to identify the transition from the catabolic to the anabolic phase and to guide nutritional therapy. The primary objective is to assess the correlation between the urea-to-creatinine ratio and energy expenditure in septic shock patients. Secondary objectives include evaluating changes in systemic inflammation over time using C-reactive protein (CRP).
This is a prospective observational cohort study of adult patients with septic shock admitted to a medical-surgical ICU who require at least three days of mechanical ventilation and undergo indirect calorimetry. Energy expenditure will be measured at predefined intervals during the ICU stay, while urea, creatinine, and CRP levels will be collected regularly. Patients with severe renal dysfunction, renal replacement therapy, or high oxygen requirements will be excluded.
Data will be analyzed across three time periods during mechanical ventilation to examine trends in energy expenditure, urea-to-creatinine ratio, and inflammation. Demographic and clinical variables will also be collected. The study aims to determine whether changes in the urea-to-creatinine ratio mirror metabolic transitions detected by indirect calorimetry, potentially offering a practical alternative for metabolic monitoring in septic shock patients.
详细描述
Urea-to-Creatinine Ratio as a Marker of Metabolic Transition in Septic Shock: A Comparison with Indirect Calorimetry
INTRODUCTION: Patients with septic shock develop profound metabolic alterations characterized by hypermetabolism and accelerated protein catabolism, leading to loss of lean body mass and worse clinical outcomes. Indirect calorimetry is the gold standard for assessing energy expenditure and metabolic demand in critically ill patients; however, it is not widely available in ICUs.
The urea-to-creatinine ratio has been proposed as a simple and readily available marker of protein catabolism. Nevertheless, its relationship with measured energy expenditure remains unclear.
HYPOTHESIS: The urea/creatinine ratio may be an efficient catabolism marker to guide nutritional therapy in critically ill patients. Evidence to confirm this hypothesis can be obtained by comparing the urea-to-creatinine ratio with indirect calorimetry, which is the gold standard for evaluating energy expenditure and metabolic demands in these patients.
OBJECTIVES: The primary objective of this study is to evaluate the correlation between the urea-to-creatinine ratio and energy expenditure measured by indirect calorimetry in patients with septic shock, in order to identify the transition from the catabolic to the anabolic phase. This transition is expected to be reflected by a reduction in the urea-to-creatinine ratio accompanied by a decrease in measured energy expenditure.
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Adult patients with septic shock, defined according to Sepsis-3 criteria, admitted to a 53-bed medical-surgical intensive care unit between April 2026 and March
- •Eligible patients will be required to have undergone invasive mechanical ventilation for at least three consecutive days -
排除标准
- •Patients will be excluded if they had a serum creatinine level greater than 4.0 mg/dL at hospital admission, chronic kidney disease requiring dialysis, initiation of renal replacement therapy during ICU stay, or if they require an inspired oxygen fraction (FiO₂) greater than 70% on the fourth day of mechanical ventilation.
研究组 & 干预措施
Septic shock patients
Patients will be submmited to determinations os indirect calorimetry and urea-to-creatinine ratio on days 1, 4, 7, 11, 14, 17 and 20
结局指标
主要结局
Urea-to-creatinine ratio and energy expenditure measured by indirect calorimetry
时间窗: 20 days
To evaluate the correlation between the urea-to-creatinine ratio and energy expenditure measured by indirect calorimetry in patients with septic shock, in order to identify the transition from the catabolic to the anabolic phase. Urea and creatinine will be determined on days 1,4,7,11, 14,17 and 20. In the same period patients will be submmited to determination of energy expenditure by indirect calorimetry using the E-COVX module integrated into the Carescape B650 monitor (GE Healthcare, Helsinki, Finland).
次要结局
- C-reactive protein (CRP)(20 days)
研究者
José Raimundo Araujo de Azevedo
Attending physician
Hospital Sao Domingos