Acute kidney injury in severely injured patients admitted to the Intensive Care Unit

Alberto F. García; Ramiro Manzano-Nunez; Juan G. Bayona; Maria P. Naranjo; Dary Neicce Villa; Manuel Moreno; Sebastian Ossa; Juan M. Martinez; Nathalia Martinez; Juan C. Puyana

doi:10.1186/s40779-020-00277-1

Your Location：

Home >

Browse articles >

Acute kidney injury in severely injured patients admitted to the Intensive Care Unit

RESEARCH | Updated：2023-02-28

- Acute kidney injury in severely injured patients admitted to the Intensive Care Unit
- Military Medical Research Vol. 8, Issue 2, Pages: 141-147(2021)
- Affiliations：
  
  1.Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
  2.Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
  3.Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 98 #18-49, 760001 Bogotá, Colombia
  4.Méderi Hospital Universitario Mayor, Bogotá, Colombia
  5.School of Medicine, Universidad ICESI (ICESI University), Cali, Colombia
  6.Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Author bio：
  
  * ramiro.manzano@urosario.edu.co; ramiro.manzano@fvl.org.co
- Funds：
- DOI：10.1186/s40779-020-00277-1
  CLC：
- Published：2021-06
- Accepted：
Scan QR Code
García et al.: Acute kidney injury in severely injured patients admitted to the intensive care unit. Mil Med Res, 2020, 7: 47.
DOI：

García et al.: Acute kidney injury in severely injured patients admitted to the intensive care unit. Mil Med Res, 2020, 7: 47. DOI： 10.1186/s40779-020-00277-1.

摘要

Abstract

Background:

Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury (AKI) in severely injured patients admitted to the Intensive Care Unit (ICU) for whom creatine kinase (CK) levels were available.

Methods:

For this retrospective observational study

we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili (FVL) University Hospital. Our primary outcome was the incidence of AKI. Multivariate regression analysis was used to assess risk factors for this outcome.

Results:

A total of 315 patients were included. The trauma mechanisms were blunt (

=130)

penetrating (

=66) and blast (

=44) trauma. The median [interquartile range

IQR) of injury severity score (ISS) was 21 (16–29). AKI developed in 75 patients (23.8%). Multivariate regression analysis revealed that the thoracic abbreviated injury scale (AIS) value (median (IQR) in the AKI group: 3 (0–4)]

Acute Physiology and Chronic Health Evaluation (APACHE II) score [median (IQR) in the AKI group: 18 (10–27)]

CK greater than 5000 U/L

lactic acid concentration at admission

and dobutamine administration were independently associated with AKI.

Conclusions:

We found that age

APACHE II score

thoracic trauma

lactic acidosis

and dobutamine administration were independently associated with AKI. Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.

关键词

Keywords

references

Harrois A , Libert N , Duranteau J . Acute kidney injury in trauma patients . Curr Opin Crit Care . 2017 ; 23 ( 6 ): 447 - 56 .

Søvik S , Isachsen MS , Nordhuus KM , Tveiten CK , Eken T , Sunde K , et al . Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis . Intensive Care Med . 2019 ; 45 ( 4 ): 407 - 19 .

Sharp LS , Rozycki GS , Feliciano DV . Rhabdomyolysis and secondary renal failure in critically ill surgical patients . Am J Surg . 2004 ; 188 ( 6 ): 801 - 6 .

Elterman J , Zonies D , Stewart I , Fang R , Schreiber M . Rhabdomyolysis and acute kidney injury in the injured war fighter . J Trauma Acute Care Surg . 2015 ; 79 ( 4 Suppl 2 ): S171 - 4 .

El-Abdellati E , Eyselbergs M , Sirimsi H , Van Hoof V , Wouters K , Verbrugghe W , et al . An observational study on rhabdomyolysis in the intensive care unit. Exploring its risk factors and main complication: Acute kidney injury . Ann Intensive Care . 2013 ; 3 ( 1 ): 8 .

Huerta-Alardín AL , Varon J , Marik PE . Bench-to-bedside review: Rhabdomyolysis – an overview for clinicians . Crit Care . 2005 ; 9 ( 2 ): 158 - 69 .

Brown C , Rhee P , Chan L , Evans K , Demetriades D , Velmahos G . Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma Acute Care Surg . 2004 ; 56 ( 6 ): 1191 - 6 .

Kellum JA , Lameire N . Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1) . Crit Care . 2013 ; 17 ( 1 ): 204 .

D’Agostino RB , Belanger A . A suggestion for using powerful and informative tests of normality . Am Stat . 1990 ; 44 ( 4 ): 316 - 21 .

Harrois A , Soyer B , Gauss T , Hamada S , Raux M , Duranteau J , et al . Prevalence and risk factors for acute kidney injury among trauma patients: a multicenter cohort study . Crit Care . 2018 ; 22 ( 1 ): 344 .

Sauaia A , Moore FA , Moore EE , Haenel JB , Read RA , Lezotte DC . Early predictors of postinjury multiple organ failure . Arch Surg . 1994 ; 129 ( 1 ): 39 - 45 .

Vogel JA , Liao MM , Hopkins E , Seleno N , Byyny RL , Moore EE , et al . Prediction of postinjury multiple-organ failure in the emergency department: development of the Denver emergency department trauma organ failure score . J Trauma Acute Care Surg . 2014 ; 76 ( 1 ): 140 - 5 .

Dewar DC , Tarrant SM , King KL , Balogh ZJ . Changes in the epidemiology and prediction of multiple-organ failure after injury . J Trauma Acute Care Surg . 2013 ; 74 ( 3 ): 774 - 9 .

Fröhlich M , Lefering R , Probst C , Paffrath T , Schneider MM , Maegele M , et al . Epidemiology and risk factors of multiple-organ failure after multiple trauma: an analysis of 31,154 patients from the TraumaRegister DGU . J Trauma Acute Care Surg . 2014 ; 76 ( 4 ): 921 - 7 .

Stewart IJ , Faulk TI , Sosnov JA , Clemens MS , Elterman J , Ross JD , et al . Rhabdomyolysis among critically ill combat casualties: associations with acute kidney injury and mortality . J Trauma Acute Care Surg . 2016 ; 80 ( 3 ): 492 - 8 .

Bosch X , Poch E , Grau JM . Rhabdomyolysis and acute kidney injury . N Engl J Med . 2009 ; 361 ( 1 ): 62 - 72 .

Scharman EJ , Troutman WG . Prevention of kidney injury following rhabdomyolysis: a systematic review . Ann Pharmacother . 2013 ; 47 ( 1 ): 90 - 105 .

Wilson RF , Spencer AR , Tyburski JG , Dolman H , Zimmerman LH . Bicarbonate therapy in severely acidotic trauma patients increases mortality . J Trauma Acute Care Surg . 2013 ; 74 ( 1 ): 45 - 50 .

Cooper D , Walley K , Wiggs B , Russell J . Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis: a prospective, controlled clinical study . Ann Intern Med . 1990 ; 112 ( 7 ): 492 - 8 .

Nielsen JS , Sally M , Mullins RJ , Slater M , Groat T , Gao X , et al . Bicarbonate and mannitol treatment for traumatic rhabdomyolysis revisited . Am J Surg . 2017 ; 213 ( 1 ): 73 - 9 .

Chavez LO , Leon M , Einav S , Varon J . Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice . Crit Care . 2016 ; 20 ( 1 ): 135 .

Cotton BA , Guy JS , Morris JAJ , Abumrad NN . The cellular, metabolic, and systemic consequences of aggressive fluid resuscitation strategies . Shock . 2006 ; 26 ( 2 ): 115 - 21 .

Sever MS , Vanholder R , Ashkenazi I , Becker G , Better O , Covic A , et al . Recommendations for the management of crush victims in mass disasters . Nephrol Dial Transplant . 2012 ; 27 ( Suppl_1 ): i1 - 67 .

Bihorac A , Delano MJ , Schold JD , Lopez MC , Nathens AB , Maier RV , et al . Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients . Ann Surg . 2010 ; 252 ( 1 ): 158 - 65 .

Odom SR , Howell MD , Silva GS , Nielsen VM , Gupta A , Shapiro NI , et al . Lactate clearance as a predictor of mortality in trauma patients . J Trauma Acute Care Surg . 2013 ; 74 ( 4 ): 999 - 1004 .

Régnier M-A , Raux M , Le Manach Y , Asencio Y , Gaillard J , Devilliers C , et al . Prognostic significance of blood lactate and lactate clearance in trauma patients . Anesthesiology . 2012 ; 117 ( 6 ): 1276 - 88 .

Dezman ZD , Comer AC , Smith GS , Narayan M , Scalea TM , Hirshon JM . Failure to clear elevated lactate predicts 24-hour mortality in trauma patients . J Trauma Acute Care Surg . 2015 ; 79 ( 4 ): 580 - 5 .

Miller PR , Meredith JW , Chang MC . Randomized, prospective comparison of increased preload versus inotropes in the resuscitation of trauma patients: effects on cardiopulmonary function and visceral perfusion . J Trauma Acute Care Surg . 1998 ; 44 ( 1 ): 107 - 13 .

Morris JA , Mucha P , Ross SE , Moore BF , Hoyt DB , Gentilello L , et al . Acute posttraumatic renal failure: A multicenter perspective . J Trauma . 1991 ; 31 ( 12 ): 1584 - 90 .

Nadvi SS , Mokoena T , Gouws E , Haffejee AA . Prognosis in posttraumatic acute renal failure is adversely influenced by hypotension and hyperkalaemia . Eur J Surg . 1996 ; 162 ( 2 ): 121 - 4 .

Roumen RM , Hendriks T , van der Ven-Jongekrijg J , Nieuwenhuijzen GA , Sauerwein RW , van der Meer JW , et al . Cytokine patterns in patients after major vascular surgery, hemorrhagic shock, and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure . Ann Surg . 1993 ; 218 ( 6 ): 769 - 76 .

Jastrow KM , Gonzalez EA , McGuire MF , Suliburk JW , Kozar RA , Iyengar S , et al . Early cytokine production risk stratifies trauma patients for multiple organ failure . J Am Coll Surg . 2009 ; 209 ( 3 ): 320 - 31 .

Bagshaw SM , George C , Gibney RTN , Bellomo R . A multi-center evaluation of early acute kidney injury in critically ill trauma patients . Ren Fail . 2008 ; 30 ( 6 ): 581 - 9 .

Views

Downloads

CSCD

Alert me when the article has been cited

Submit

Tools

Publicity Resources

Effect of early administration of tetracosactide on mortality and host response in critically ill patients requiring rescue surgery: a sensitivity analysis of the STOPSHOCK phase 3 randomized controlled trial

Poor sleep and decreased cortical thickness in veterans with mild traumatic brain injury and post-traumatic stress disorder

Sepsis in burn care: incidence and outcomes

Disentangling the effects of PTSD from Gulf War Illness in male veterans via a systems-wide analysis of immune cell, cytokine, and symptom measures

Pre-hospital application of REBOA for life-threatening hemorrhage

Related Author

Alfio Bertolini

Laura Calzà

Mercedes Gori

Annalisa Pitino

Graziella D’Arrigo

Colin Gerard Egan

Giovanni Tripepi

Giorgio Noera

Related Institution

CE Medical Writing SRLS

National Research Council-Institute of Clinical Physiology

Institute of Clinical Physiology (IFC-CNR), Section of Rome

IRET Foundation, Ozzano Dell’ Emilia

Department of Medicine and Division of Clinical Pharmacology, School of Medicine, UNIMORE, Policlinico

⁰