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

Abstract

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.

• Authors: Max V Wohlauer, Angela Sauaia, Ernest E Moore, Clay Cothren Burlew, Anirban Banerjee, Jeffrey Johnson
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 72 Issue 2 Pg. 373-8; discussion 379-80 (Feb 2012) ISSN: 2163-0763 [Electronic] United States
• PMID: 22327979 (Publication Type: Journal Article)

Topics

• 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, etiology, physiopathology, therapy)
• Prognosis
• Prospective Studies
• Renal Replacement Therapy
• Risk Factors
• Statistics, Nonparametric
• Survival Rate