Background: As more patients are surviving the initial effects of traumatic injury clinicians are faced with managing the systemic complications of severe tissue injury. Of these, acute kidney injury (AKI) may be a sentinel complication contributing to adverse outcomes.
Objective: To establish the incidence of AKI in patients admitted to critical care after major trauma, to explore any risk factors and to evaluate the association of AKI with outcomes.
Data sources: Systematic search of MEDLINE, Excerpta Medica database and Cochrane library from January 2004 to April 2018.
Study selection: Studies of adult major trauma patients admitted to critical care that applied consensus AKI criteria (risk injury failure loss end stage [RIFLE], AKI network, or kidney disease improving global outcomes) and reported clinical outcomes were assessed (PROSPERO Registration: CRD42017056781). Of the 35 full-text articles selected from the screening, 17 (48.6%) studies were included.
Data extraction and synthesis: We followed the PRISMA guidelines and study quality was assessed using the Newcastle-Ottawa score. The pooled incidence of AKI and relative risk of death were estimated using random-effects models.
Main outcomes and measures: Incidence of AKI was the primary outcome. The secondary outcome was study-defined mortality.
Results: We included 17 articles describing AKI outcomes in 24,267 trauma patients. The pooled incidence of AKI was 20.4% (95% confidence interval [CI], 16.5-24.9). Twelve studies reported the breakdown of stages of AKI with 55.7% of patients classified as RIFLE-R or stage 1, 30.3% as RIFLE-I or stage 2, and 14.0% as RIFLE-F or stage 3. The pooled relative risk of death with AKI compared was 3.6 (95% CI, 2.4-5.3). In addition, there was a concordant increase in odds of death among six studies that adjusted for multiple variables (adjusted odds ratio, 2.7; 95% CI, 1.9-3.8; p = <0.01).
Conclusion: Acute kidney injury is common after major trauma and associated with increased mortality. Future research is warranted to reduce the potential for harm associated with this subtype of AKI.
Level of evidence: Systematic review and meta-analysis, level III.
Acute Kidney Injury in Burn Patients Admitted to the Intensive Care Unit: A Systematic Review and Meta-AnalysisT Folkestad et al. Crit Care 24 (1), 2. PMID 31898523.AKI occurred in 38% of burn patients admitted to the ICU, and 12% of all patients received RRT. Presence of AKI was associated with increased LOS and mortality.
Acute Kidney Injury in Trauma Patients Admitted to the ICU: A Systematic Review and Meta-AnalysisS Søvik et al. Intensive Care Med 45 (4), 407-419. PMID 30725141. - ReviewAKI occurred in 24% of trauma patients admitted to the ICU, with an RRT use among these of 10%. Presence of AKI was associated with increased LOS and mortality, but renal …
Hydroxyethyl Starch (HES) Versus Other Fluid Therapies: Effects on Kidney FunctionTC Mutter et al. Cochrane Database Syst Rev (7), CD007594. PMID 23881659. - ReviewThe current evidence suggests that all HES products increase the risk in AKI and RRT in all patient populations and a safe volume of any HES solution has yet to be determ …
Acute Kidney Injury Defined According to the 'Risk,' 'Injury,' 'Failure,' 'Loss,' and 'End-stage' (RIFLE) Criteria After Repair for a Ruptured Abdominal Aortic AneurysmSC van Beek et al. J Vasc Surg 60 (5), 1159-1167.e1. PMID 24998838.The incidence of AKI defined according to the RIFLE criteria (74%) was greater than defined using the SVS/ISCVS reporting standards (48%) and patients categorized as 'Fai …
Acute Kidney Injury After Craniotomy Is Associated With Increased Mortality: A Cohort StudyVP Kovacheva et al. Neurosurgery 79 (3), 389-96. PMID 26645967.Craniotomy patients who suffer postoperative AKI are among a high-risk group for mortality. The severity of AKI after craniotomy is predictive of 30-day mortality.
Cited by 4 PubMed Central articles
Procalcitonin to Allow Early Detection of Sepsis and Multiple Organ Failure in Severe Multiple Trauma: Beware of Some ConfoundersPM Honore et al. Crit Care 24 (1), 9. PMID 31910884.
Incidence Of, Risk Factors For, and Mortality Associated With Severe Acute Kidney Injury After Gunshot WoundAM Athavale et al. JAMA Netw Open 2 (12), e1917254. PMID 31825505.In this cross-sectional study, SAKI among civilians who experienced GSWs was associated with mortality.
Deserved Attention for Acute Kidney Injury After Major TraumaRW Haines et al. Intensive Care Med 45 (6), 907-908. PMID 31016354.
Trauma Induced Acute Kidney InjuryZB Perkins et al. PLoS One 14 (1), e0211001. PMID 30682106. - Clinical TrialAKI 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 …