Abstract
Purpose
To perform a systematic review and meta-analysis of acute kidney injury (AKI) in trauma patients admitted to the intensive care unit (ICU).
Methods
We conducted a systematic literature search of studies on AKI according to RIFLE, AKIN, or KDIGO criteria in trauma patients admitted to the ICU (PROSPERO CRD42017060420). We searched PubMed, Cochrane Database of Systematic Reviews, UpToDate, and NICE through 3 December 2018. Data were collected on incidence of AKI, risk factors, renal replacement therapy (RRT), renal recovery, length of stay (LOS), and mortality. Pooled analyses with random effects models yielded mean differences, OR, and RR, with 95% CI.
Results
Twenty-four observational studies comprising 25,182 patients were included. Study quality (Newcastle–Ottawa scale) was moderate. Study heterogeneity was substantial. Incidence of post-traumatic AKI in the ICU was 24% (20–29), of which 13% (10–16) mild, 5% (3–7) moderate, and 4% (3–6) severe AKI. Risk factors for AKI were African American descent, high age, chronic hypertension, diabetes mellitus, high Injury Severity Score, abdominal injury, shock, low Glasgow Coma Scale (GCS) score, high APACHE II score, and sepsis. AKI patients had 6.0 (4.0–7.9) days longer ICU LOS and increased risk of death [RR 3.4 (2.1–5.7)] compared to non-AKI patients. In patients with AKI, RRT was used in 10% (6–15). Renal recovery occurred in 96% (78–100) of patients.
Conclusions
AKI occurred in 24% of trauma patients admitted to the ICU, with an RRT use among these of 10%. Presence of AKI was associated with increased LOS and mortality, but renal recovery in AKI survivors was good.
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References
Bagshaw SM, George C, Gibney RTN, Bellomo R (2008) A multi-center evaluation of early acute kidney injury in critically ill trauma patients. Ren Fail 30:581–589. https://doi.org/10.1080/08860220802134649
Skinner DL, Hardcastle TC, Rodseth RN, Muckart DJJ (2014) The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit. Injury 45:259–264. https://doi.org/10.1016/j.injury.2013.07.013
Bellomo R, Ronco C, Kellum JA et al (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212
Mehta RL, Kellum JA, Shah SV et al (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 11:R31
Kidney Disease: Improving Global Outcomes KDIGO Acute Kidney Injury Work Group (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1–138. https://doi.org/10.1038/kisup.2012.1
Joannidis M, Druml W, Forni LG et al (2017) Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med 43:730–749. https://doi.org/10.1007/s00134-017-4832-y
Gatward JJ, Gibbon GJ, Wrathall G, Padkin A (2008) Renal replacement therapy for acute renal failure: a survey of practice in adult intensive care units in the United Kingdom. Anaesthesia 63:959–966. https://doi.org/10.1111/j.1365-2044.2008.05514.x
Villeneuve P-M, Clark EG, Sikora L et al (2016) Health-related quality-of-life among survivors of acute kidney injury in the intensive care unit: a systematic review. Intensive Care Med 42:137–146. https://doi.org/10.1007/s00134-015-4151-0
Rimes-Stigare C, Awad A, Mårtensson J et al (2012) Long-term outcome after acute renal replacement therapy: a narrative review. Acta Anaesthesiol Scand 56:138–146. https://doi.org/10.1111/j.1399-6576.2011.02567.x
Gallagher M, Cass A, Bellomo R et al (2014) Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med 11:e1001601. https://doi.org/10.1371/journal.pmed.1001601
Chawla LS, Eggers PW, Star RA, Kimmel PL (2014) Acute kidney injury and chronic kidney disease as interconnected syndromes. N Engl J Med 371:58–66. https://doi.org/10.1056/NEJMra1214243
Søvik S, Isachsen MS, Nordhuus KM, et al (2018) Acute kidney injury in trauma patients admitted to the intensive care unit: a systematic review and meta-analysis. In: 31st annual congress of the European Society of Intensive Care Medicine, Paris, 20–24 October 2018
Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196
Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636. https://doi.org/10.1378/chest.100.6.1619
Wells GA, Shea B, OConnell D, et al (2000) The Newcastle–Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 01 Jan 2019
R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/
Schwarzer G (2015) Meta: general package for meta-analysis, R Package Version 4.3–2. https://CRAN.R-project.org/package=meta
Gordon M, Lumley T (2017) forestplot: Advanced forest plot using “grid” graphics. R package version 1.7. https://CRAN.R-project.org/package=forestplot
Higgins JPT, Deeks JJ (eds) (2011) Chapter 7: Selecting studies and collecting data. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org
Schünemann HJ, Oxman AD, Vist GE et al (2011) Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org
Cochran WG (2018) The combination of estimates from different experiments. Biometrics 10:101–129
Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/bmj.327.7414.557
Sedgwick P (2015) Meta-analyses: what is heterogeneity? BMJ 350:h1435. https://doi.org/10.1136/bmj.h1435
Heegard KD, Stewart IJ, Cap AP et al (2015) Early acute kidney injury in military casualties. J Trauma Acute Care Surg 78:988–993. https://doi.org/10.1097/TA.0000000000000607
Ülger F, Pehlivanlar Küçük M, Küçük AO et al (2018) Evaluation of acute kidney injury (AKI) with RIFLE, AKIN, CK, and KDIGO in critically ill trauma patients. Eur J Trauma Emerg Surg 44:597–605. https://doi.org/10.1007/s00068-017-0820-8
Baitello AL, Marcatto G, Yagi RK (2013) Risk factors for injury acute renal in patients with severe trauma and its effect on mortality. J Bras Nefrol 35:127–131. https://doi.org/10.5935/0101-2800.20130021
Kamar C, Ali A, Altun D et al (2017) Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment. Ulus Travma Acil Cerrahi Derg 23:39–45. https://doi.org/10.5505/tjtes.2016.83451
Kim DY, Kobayashi L, Costantini TW et al (2012) Is contrast exposure safe among the highest risk trauma patients? J Trauma Acute Care Surg 72:61–66. https://doi.org/10.1097/ta.0b013e31823f36e0 (discussion 66–7)
Leberle R, Ernstberger A, Loibl M et al (2015) Association of high volumes of hydroxyethyl starch with acute kidney injury in elderly trauma patients. Injury 46:105–109. https://doi.org/10.1016/j.injury.2014.08.039
Moore EM, Bellomo R, Nichol A et al (2010) The incidence of acute kidney injury in patients with traumatic brain injury. Ren Fail 32:1060–1065. https://doi.org/10.3109/0886022X.2010.510234
Prodhan P, McCage LS, Stroud MH et al (2012) Acute kidney injury is associated with increased in-hospital mortality in mechanically ventilated children with trauma. J Trauma Acute Care Surg 73:832–837. https://doi.org/10.1097/TA.0b013e31825ab14f
Santos PR, Monteiro DLS (2015) Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study. BMC Nephrol 16:30. https://doi.org/10.1186/s12882-015-0026-4
Saour M, Charbit J, Millet I et al (2014) Effect of renal angioembolization on post-traumatic acute kidney injury after high-grade renal trauma: a comparative study of 52 consecutive cases. Injury 45:894–901. https://doi.org/10.1016/j.injury.2013.11.030
Talving P, Karamanos E, Skiada D et al (2013) Relationship of creatine kinase elevation and acute kidney injury in pediatric trauma patients. J Trauma Acute Care Surg 74:912–916. https://doi.org/10.1097/TA.0b013e318278954e
Zand F, Sabetian G, Abbasi G et al (2015) Early acute kidney injury based on serum creatinine or cystatin C in intensive care unit after major trauma. Iran J Med Sci 40:485–492
de Abreu KLS, Silva Júnior GB, Barreto AGC et al (2010) Acute kidney injury after trauma: prevalence, clinical characteristics and RIFLE classification. Indian J Crit Care Med 14:121–128. https://doi.org/10.4103/0972-5229.74170
Ahmed M, Sriganesh K, Vinay B, Umamaheswara Rao GS (2015) Acute kidney injury in survivors of surgery for severe traumatic brain injury: incidence, risk factors, and outcome from a tertiary neuroscience center in India. Br J Neurosurg 29:544–548. https://doi.org/10.3109/02688697.2015.1016892
Bihorac A, Delano MJ, Schold JD et al (2010) Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients. Ann Surg 252:158–165. https://doi.org/10.1097/SLA.0b013e3181deb6bc
Costantini TW, Fraga G, Fortlage D et al (2009) Redefining renal dysfunction in trauma: implementation of the Acute Kidney Injury Network staging system. J Trauma 67:283–287. https://doi.org/10.1097/ta.0b013e3181a51a51 (discussion 287–8)
Eriksson M, Brattström O, Mårtensson J et al (2015) Acute kidney injury following severe trauma: risk factors and long-term outcome. J Trauma Acute Care Surg 79:407–412. https://doi.org/10.1097/TA.0000000000000727
Fang L, You H, Chen B et al (2010) Mannitol is an independent risk factor of acute kidney injury after cerebral trauma: a case-control study. Ren Fail 32:673–679. https://doi.org/10.3109/0886022X.2010.486492
Fujinaga J, Kuriyama A, Shimada N (2017) Incidence and risk factors of acute kidney injury in the Japanese trauma population: a prospective cohort study. Injury 48:2145–2149. https://doi.org/10.1016/j.injury.2017.08.022
Gomes E, Antunes R, Dias C et al (2010) Acute kidney injury in severe trauma assessed by RIFLE criteria: a common feature without implications on mortality? Scand J Trauma Resusc Emerg Med 18:1. https://doi.org/10.1186/1757-7241-18-1
Haines RW, Lin S-P, Hewson R et al (2018) Acute kidney injury in trauma patients admitted to critical care: development and validation of a diagnostic prediction model. Sci Rep 8:3665. https://doi.org/10.1038/s41598-018-21929-2
Li N, Zhao W-G, Zhang W-F (2011) Acute kidney injury in patients with severe traumatic brain injury: implementation of the Acute Kidney Injury Network stage system. Neurocrit Care 14:377–381. https://doi.org/10.1007/s12028-011-9511-1
Li N, Zhao W-G, Xu F-L et al (2013) Neutrophil gelatinase-associated lipocalin as an early marker of acute kidney injury in patients with traumatic brain injury. J Nephrol 26:1083–1088. https://doi.org/10.5301/jn.5000282
Makris K, Markou N, Evodia E et al (2009) Urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in critically ill multiple trauma patients. Clin Chem Lab Med 47:79–82. https://doi.org/10.1515/CCLM.2009.004
Podoll AS, Kozar R, Holcomb JB, Finkel KW (2013) Incidence and outcome of early acute kidney injury in critically-ill trauma patients. PLoS One 8:e77376. https://doi.org/10.1371/journal.pone.0077376
Raju NA, Rao SV, Joel JC et al (2017) Predictive value of serum myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis. Indian J Crit Care Med 21:852–856. https://doi.org/10.4103/ijccm.IJCCM_186_17
Reilly JP, Anderson BJ, Mangalmurti NS et al (2015) The ABO histo-blood group and AKI in critically Ill patients with trauma or sepsis. Clin J Am Soc Nephrol 10:1911–1920. https://doi.org/10.2215/CJN.12201214
Shashaty MGS, Meyer NJ, Localio AR et al (2012) African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients. J Crit Care 27:496–504. https://doi.org/10.1016/j.jcrc.2012.02.002
Skinner DL, Laing GL, Bruce J et al (2017) Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries. S Afr Med J 107:446–450. https://doi.org/10.7196/SAMJ.2017.v107i5.12213
Skrifvars MB, Moore E, Mårtensson J et al (2018) Erythropoietin in traumatic brain injury associated acute kidney injury: a randomized controlled trial. Acta Anaesthesiol Scand 63:200–207. https://doi.org/10.1111/aas.13244
Stewart IJ, Sosnov JA, Howard JT, Chung KK (2016) Acute kidney injury in critically injured combat veterans: a retrospective cohort study. Am J Kidney Dis 68:564–570. https://doi.org/10.1053/j.ajkd.2016.03.419
Yuan F, Hou FF, Wu Q et al (2009) Natural history and impact on outcomes of acute kidney injury in patients with road traffic injury. Clin Nephrol 71:669–679
Hoste EAJ, Bagshaw SM, Bellomo R et al (2015) Epidemiology of acute kidney injury in critically ill patients: the multinational AKI–EPI study. Intensive Care Med 41:1411–1423. https://doi.org/10.1007/s00134-015-3934-7
Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818. https://doi.org/10.1001/jama.294.7.813
Maheshwari K, Nathanson BH, Munson SH et al (2018) The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Intensive Care Med 44:857–867. https://doi.org/10.1007/s00134-018-5218-5
Lee SA, Cozzi M, Bush EL, Rabb H (2018) Distant organ dysfunction in acute kidney injury: a review. Am J Kidney Dis 72:846–856. https://doi.org/10.1053/j.ajkd.2018.03.028
Husain-Syed F, Ricci Z, Brodie D et al (2018) Extracorporeal organ support (ECOS) in critical illness and acute kidney injury: from native to artificial organ crosstalk. Intensive Care Med 44:1447–1459. https://doi.org/10.1007/s00134-018-5329-z
Parikh A, Shaw A (2012) The economics of renal failure and kidney disease in critically ill patients. Crit Care Clin 28:99–111. https://doi.org/10.1016/j.ccc.2011.10.006 vii
Forni LG, Darmon M, Ostermann M et al (2017) Renal recovery after acute kidney injury. Intensive Care Med 43:855–866. https://doi.org/10.1007/s00134-017-4809-x
Skaga NO, Eken T, Jones JM, Steen PA (2008) Different definitions of patient outcome: consequences for performance analysis in trauma. Injury 39:612–622. https://doi.org/10.1016/j.injury.2007.11.426
Moore L, Turgeon AF, Emond M et al (2011) Definition of mortality for trauma center performance evaluation: a comparative study. Crit Care Med 39:2246–2252. https://doi.org/10.1097/CCM.0b013e3182227a59
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Søvik, S., Isachsen, M.S., Nordhuus, K.M. et al. Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis. Intensive Care Med 45, 407–419 (2019). https://doi.org/10.1007/s00134-019-05535-y
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DOI: https://doi.org/10.1007/s00134-019-05535-y