Journal Article

Trauma induced acute kidney injury

O’Brien, Benjamin, Bird, Ruth, Captur, Gabriella, Perkins, Zane B., Singer, Ben, Gleeson, Liam

2019

Overview

Injured patients are at risk of developing acute kidney injury (AKI), which is associated with increased morbidity and mortality. The aim of this study is to describe the incidence, timing, and severity of AKI in a large trauma population, identify risk factors for AKI, and report mortality outcomes. A prospective observational study of injured adults, who met local criteria for trauma team activation, and were admitted to a UK Major Trauma Centre. AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression and Cox proportional hazard modelling was used to analyse parameters associated with AKI and mortality. Of the 1410 patients enrolled in the study, 178 (12.6%) developed AKI. Age; injury severity score (ISS); admission systolic blood pressure, lactate and serum creatinine; units of Packed Red Blood Cells transfused in first 24 hours and administration of nephrotoxic therapy were identified as independent risk factors for the development of AKI. Patients that developed AKI had significantly higher mortality than those with normal renal function (47/178 [26.4%] versus 128/1232 [10.4%]; OR 3.09 [2.12 to 4.53]; p<0.0001). After adjusting for other clinical prognostic factors, AKI was an independent risk factor for mortality. AKI is a frequent complication following trauma and is associated with prolonged hospital length of stay and increased mortality. Future research is needed to improve our ability to rapidly identify those at risk of AKI, and develop resuscitation strategies that preserve renal function in trauma patients.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acute Kidney Injury - blood / Acute Kidney Injury - etiology / Acute Kidney Injury - mortality / Acute Kidney Injury - therapy / Adolescent / Adult / Adults / Aged / Aged, 80 and over / Analysis / Biology and Life Sciences / Blood cells / Blood Pressure / Complications and side effects / Creatinine / Creatinine - blood / Critical care / Disease-Free Survival / Emergency medical care / Erythrocytes / Female / Health risks / Heart / Hospitals / Humans / Incidence / Injuries / Kidney diseases / Kidneys / Lactic acid / Lactic Acid - blood / Male / Medicine and Health Sciences / Middle Aged / Morbidity / Mortality / Nephrology / Observational studies / Outcome and process assessment (Medical care) / Patient outcomes / Patients / Prospective Studies / Regression analysis / Renal function / Renal replacement therapy / Resuscitation / Risk analysis / Risk Factors / Sepsis / Surgery / Survival Rate / Systematic review / Trauma / Wounds and Injuries - blood / Wounds and Injuries - complications / Wounds and Injuries - mortality / Wounds and Injuries - therapy