Renal Dysfunction in Trauma: Even a Little Costs a Lot

Abstract

Vigilance in preventing creatinine increases and ameliorating or removing potential causes should occur as soon as creatinine begins to rise to avoid worsening renal function, to reduce cost, and to improve patient outcome.

A Multi-Center Evaluation of Early Acute Kidney Injury in Critically Ill Trauma Patients

“…[2,3,7,[38][39][40] However, few have focused on describing the mortality associated with AKI in trauma. [21,25,27] Our data further strengthen the findings of prior investigations by showing that early AKI is associated with higher crude and adjusted mortality in ICU patients with trauma. [21,25,27] In the only other study to evaluate early AKI in trauma, Ala-Kokko et al showed that "renal failure" defined by SOFA score >2 had an adjusted OR of 8.2 for hospital mortality.…”

“…Brandt et al found that "renal failure" occurred in 23.8% of patients when defined by an absolute serum creatinine >133μmol/L or a relative changes of >50% or >44 μmol/L. [21] While similar to our incidence estimate, this study was performed at a single level I trauma center and thus potentially prone to selection bias. Recently, the RIFLE criteria were applied in a single-center study of 304 critically ill burn patients (>10% total-body surface area).…”

“…[21] Emerging data suggest that the burden of AKI in trauma may be increasing; however, most studies to date are limited by small sample size, [23,24,26] single-center design, [21,26,28] focus on selected trauma populations, [22] or use of variable definitions for AKI, [21,25,27] or are potentially confounded by including late or delayed-onset of AKI that may not be attributable to trauma. [21,25,27] An evaluation of the epidemiology of AKI in trauma is important for health resource allocation, identification of high risk populations, development of preventative strategies, and for surveillance of long-term clinical consequences. Accordingly, we interrogated the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database (APD) to obtain information on the epidemiology of early AKI, defined as AKI evident within 24 hours of ICU admission, for all ICU admissions related to trauma from 57 Australian ICUs over a five-year period.…”

“…More recently, Brandt et al conducted a single-center retrospective study of 1,033 ICU admissions for trauma and found AKI occurred in 23.8%. [21] Of these, 10% required initiation of RRT. Moreover, this study found that AKI in trauma was associated with a longer duration of mechanical ventilation and stay in ICU.…”

“…[6] To date, only a few studies have described the epidemiology of AKI attributable to trauma. [21][22][23][24][25][26][27] Morris et al performed a retrospective study of 72,757 admissions to nine regional trauma centers over a five-year period and found only 78 patients (0.1%) developed AKI requiring renal replacement therapy (RRT). [25] While these data might suggest AKI in trauma is rare, it did not focus on trauma requiring ICU admission.…”