Acute kidney injury and posttrauma multiple organ failure: the canary in the coal mine

J Trauma Acute Care Surg. 2012 Feb;72(2):373-8; discussion 379-80. doi: 10.1097/TA.0b013e318244869b.


Background: Despite improved resuscitation strategies, acute kidney injury (AKI) remains an important cause of morbidity and high resource use among severely injured patients. Thus, we conducted a comprehensive evaluation of the epidemiology and outcomes of early AKI among severely injured patients as well as its impact on the development of postinjury multiple organ failure (MOF).

Methods: We queried our 17-year database of high-risk postinjury patients (Injury Severity Score >15, age >15 years, survival >48 hours, and no isolated head injury). MOF and AKI (creatinine >1.8 mg/dL) were defined by the Denver MOF score. Patients with documented preexisting renal, hepatic, cardiac, or pulmonary disease (120, 5%) were excluded, leaving 2157 for analysis.

Results: Early (day 2) AKI was evident in 2.13% of the patients and associated with a 78% MOF incidence and 27% mortality. Both rates were higher than those associated with early heart, lung, or liver failure.

Conclusion: Early AKI is a harbinger of adverse outcome postinjury, outperforming hepatic, cardiac, or pulmonary dysfunction as a predictor of MOF and death. Prevention of early AKI and a better understanding of organ crosstalk may help reduce AKI-associated morbidity, mortality, and obligatory costs of this complication.

Level of evidence: I, prognostic study.

MeSH terms

  • Acute Disease
  • Adult
  • Chi-Square Distribution
  • Colorado / epidemiology
  • Female
  • Humans
  • Incidence
  • Injury Severity Score
  • Kidney / injuries*
  • Kidney Function Tests
  • Logistic Models
  • Male
  • Middle Aged
  • Multiple Organ Failure / epidemiology
  • Multiple Organ Failure / etiology
  • Multiple Organ Failure / physiopathology*
  • Multiple Organ Failure / therapy*
  • Prognosis
  • Prospective Studies
  • Renal Replacement Therapy
  • Risk Factors
  • Statistics, Nonparametric
  • Survival Rate