Urea to creatinine ratio as a predictor of illness severity and clinical outcomes in critically ill patients.

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Background: Abnormalities in renal function or nitrogen balance, reflected by the urea-to-creatinine ratio emerge during ICU stay have impact role on functional recovery during critical illness. Methods: This study involved 58 patients with moderate to severe critical illness in the ICU at Minia University’s anesthesia department. Exclusions were patients under 18, with chronic comorbidities, or insufficient data. The APACHE II score, SOFA score, and urea-to-creatinine ratio were assessed on days 1, 4, and 7. Results: The mean patient age was 64±11.6 years, with a near-equal sex distribution. The median APACHE II score was 21. SOFA scores improved significantly from a median of 8 on day 1 to 5.5 on day 7 (p<0.001). Urea/creatinine ratio increased progressively from 100.8±14.9 on day 1 to 121.4±20.8 on day 7, with significant changes between day 1 vs 7 (p<0.001) and day 4 vs 7 (p<0.001). The average ICU stay was 11±2.9 days, with a median Katz-index of 4, indicating partial independence in daily living. Conclusion: Changes in the urea-to-creatinine ratio during critical illness reflect disease severity and may impact functional recovery. Despite clinical improvements in SOFA scores, the progressive rise in the urea-to-creatinine ratio suggests dissociation between organ function recovery and metabolic stress markers.

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