Acute kidney injury in severely injured patients admitted to the intensive care unit
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RESEARCH
Open Access
Acute kidney injury in severely injured patients admitted to the intensive care unit Alberto F. García1,2, Ramiro Manzano-Nunez3,4*, Juan G. Bayona1,2, Maria P. Naranjo1,2, Dary Neicce Villa1,2, Manuel Moreno5, Sebastian Ossa5, Juan M. Martinez5, Nathalia Martinez5 and Juan C. Puyana6
Abstract Background: Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury (AKI) in severely injured patients admitted to the intensive care unit (ICU) for whom creatine kinase (CK) levels were available. Methods: For this retrospective observational study, we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili (FVL) University Hospital. Our primary outcome was the incidence of AKI. Multivariate regression analysis was used to assess risk factors for this outcome. Results: A total of 315 patients were included. The trauma mechanisms were blunt (n = 130), penetrating (n = 66) and blast (n = 44) trauma. The median (interquartile range, IQR) of injury severity score (ISS) was 21 (16–29). AKI developed in 75 patients (23.8%). Multivariate regression analysis revealed that the thoracic abbreviated injury scale (AIS) value (median (IQR) in the AKI group: 3 (0–4)), Acute Physiology and Chronic Health Evaluation (APACHE II) score (median (IQR) in the AKI group: 18 (10–27)), CK greater than 5000 U/L, lactic acid concentration at admission, and dobutamine administration were independently associated with AKI. Conclusion: We found that age, APACHE II score, thoracic trauma, lactic acidosis, and dobutamine administration were independently associated with AKI. Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients. Keywords: Rhabdomyolysis, Wounds and injuries, Acute kidney injury, Critical care, Trauma
Background Organ dysfunction is a common event among trauma patients who survive the initial insult and undergo damage control resuscitation interventions. Acute kidney injury (AKI), which is one type of organ dysfunction, is often present in severely injured patients, and its occurrence is associated with higher risk-adjusted odds of poor outcomes [1], such as greater critical care resource utilization and higher mortality [2]. * Correspondence: [email protected]; [email protected] 3 Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 98 #18-49, 760001 Bogotá, Colombia 4 Méderi Hospital Universitario Mayor, Bogotá, Colombia Full list of author information is available at the end of the article
Although previous studies have assessed the frequency and factors associated with AKI in trauma patients, the existing literature about the risk factors for AKI after traumatic injuries has its limitations. Published studies have analyzed patients with traumatic and nontraumatic rhabdomyolysis through univariate analyses [3, 4], and variables that can act as
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