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Clinical Trial
, 14 (1), e0211001
eCollection

Trauma Induced Acute Kidney Injury

Affiliations
Clinical Trial

Trauma Induced Acute Kidney Injury

Zane B Perkins et al. PLoS One.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Kaplan-Meier estimates of freedom from acute kidney injury in 1410 injured adults.
Fig 2
Fig 2. Serum creatinine levels for the first 28 days following injury, according to renal function.
Data are presented as median with interquartile range.
Fig 3
Fig 3. Kaplan Meier estimates of 60-day survival, according to renal function.
Fig 4
Fig 4. The proportion of trauma deaths associated with acute kidney injury.

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