Identifying augmented renal clearance in trauma patients: Validation of the augmented renal clearance in trauma intensive care (ARCTIC) scoring system.

Background: Augmented renal clearance (ARC) is common in trauma patients and associated with subtherapeutic antimicrobial concentrations. This study reported the incidence of ARC, identified ARC risk factors and described a model to predict ARC (i.e.,ARCTIC) that is specific to trauma patients. Methods: Consecutive trauma patients who were admitted to the ICU between March 2015 and January 2016 and had a measured creatinine clearance (CrCl) were considered for inclusion. Patients were excluded if their serum creatinine (SCr) was >1.3 mg/dL. ARC was defined as a measured CrCl >=130ml/min. Demographic and trauma-specific variables were then compared and multivariate analysis was performed. Using these results, a weighted scoring system was constructed and evaluated using receiver operating characteristic (ROC) curve analysis. ARCTIC score cut-offs were chosen based on sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The derived scoring system was then compared to a previously published scoring system for accuracy. Results: There were 133 patients with a mean age of 48+/-19 years and SCr of 0.8+/-0.2 mg/dL. The mean measured CrCl was 168+/-65 ml/min and the incidence of ARC was 67%. Multivariate analysis revealed the following risk factors for ARC [odds ratios (95% CI)]: age = 6 had a sensitivity, specificity, PPV and NPV of 0.843, 0.682, 0.843 and 0.682, respectively. Conclusion: The incidence of ARC in trauma patients is high. The ARCTIC score represents a practical, pragmatic system that can be easily applied at the bedside. An ARCTIC score >=6 represents an appropriate cut-off to screen for ARC where antimicrobial adjustments should be considered. Level of Evidence: Prognostic and epidemiologic study, level III. (C) 2017 Lippincott Williams & Wilkins, Inc.

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