Acute kidney injury in severely injured patients admitted to the intensive care unit

Springer Science and Business Media LLC - 2020
Alberto García1, Ramiro Manzano-Núñez2, Juan Gabriel Bayona1, María Paula Naranjo1, Dary Neicce Villa3, Manuel Moreno4, Sebastian Ossa4, Juan M. Martínez4, Nathalia Martinez4, Juan Carlos Puyana5
1Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
2Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Carrera 98 #18-49, 760001, Bogotá, Colombia
3Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
4School of Medicine, Universidad ICESI (ICESI University), Cali, Colombia
5Department of Surgery, University of Pittsburgh, Pittsburgh, PA. USA

Tóm tắt

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.

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