J Acute Care Surg.  2020 Nov;10(3):90-95. 10.17479/jacs.2020.10.3.90.

Acute Kidney Injury After Trauma: Risk Factors and Clinical Outcomes

• Jheong JH
• Hong SK
• Kim TH

• KMID: 2512845
• DOI: http://doi.org/10.17479/jacs.2020.10.3.90

Abstract

Purpose
Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the clinical characteristics, risk factors, and outcomes of AKI after trauma.
Methods
A retrospective cohort study of 386 trauma patients who visited the emergency department at the Asan Medical Center between January 2012 and December 2013 was performed. There were 322 patients included in this study. Patients were assigned into the AKI group and no AKI group. Regression analysis was performed to identify the factors associated with development of AKI following trauma.
Results
The overall incidence of AKI following trauma was 6%. There was no difference in patients`age, sex, and body weight between groups. Whereas there was a significant difference in Injury Severity Score, Glasgow Coma Scale, presence of shock, need for a transfusion, lactic acid levels, and severe rhabdomyolysis. In multivariate analysis, the independent risk factors associated with AKI after trauma included the Injury Severity Score [odds ratio (OR) = 1.065, p < 0.01], presence of shock (OR = 3.949, p = 0.012), and severe rhabdomyolysis (OR = 4.475, p < 0.01). Patients in the AKI group were classified (according to the RIFLE criteria) as at Risk in 9 cases (43%), Injury present in 3 (14%), Failure in 7 (33%), Loss in 0 (0%) and End-stage in 2 (10%). Renal replacement therapy was required for 10 patients (47%) in the AKI group and 4 of them (40%) underwent successful weaning. Hospital mortality rate was higher in the AKI group (5/21, 23%) than the no AKI group (3/301, 1% ; p < 0.01).
Conclusion
The development of AKI was associated with the severity of trauma, and trauma increased mortality rates.

Keyword

acute kidney injury; trauma; Rhabdomyolysis