Faculty Collaboration Database

Acute kidney injury and posttrauma multiple organ failure: the canary in the coal mine. J Trauma Acute Care Surg 2012 Feb;72(2):373-8; discussion 379-80

Date

02/14/2012

Pubmed ID

22327979

DOI

10.1097/TA.0b013e318244869b

Scopus ID

2-s2.0-84860554642 (requires institutional sign-in at Scopus site)   59 Citations

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.

Author List

Wohlauer MV, Sauaia A, Moore EE, Burlew CC, Banerjee A, Johnson J

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adult
Chi-Square Distribution
Colorado
Female
Humans
Incidence
Injury Severity Score
Kidney
Kidney Function Tests
Logistic Models
Male
Middle Aged
Multiple Organ Failure
Prognosis
Prospective Studies
Renal Replacement Therapy
Risk Factors
Statistics, Nonparametric
Survival Rate