Intensive Care Medicine

, Volume 45, Issue 4, pp 407–419 | Cite as

Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis

  • Signe SøvikEmail author
  • Marie Susanna Isachsen
  • Kine Marie Nordhuus
  • Christine Kooy Tveiten
  • Torsten Eken
  • Kjetil Sunde
  • Kjetil Gundro Brurberg
  • Sigrid Beitland
Systematic Review



To perform a systematic review and meta-analysis of acute kidney injury (AKI) in trauma patients admitted to the intensive care unit (ICU).


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.


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.


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.


Acute kidney injury Wounds and injuries Critical illness Risk factors Mortality Systematic review 



This study was funded by the authors’ institutions only.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflicts of interest regarding this study.

Ethical approval

An approval by an ethics committee was not applicable.

Supplementary material

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Supplementary material 1 (PDF 68 kb)
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Supplementary material 2 (PDF 58 kb)
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Supplementary material 3 (PDF 73 kb)
134_2019_5535_MOESM4_ESM.pdf (74 kb)
Supplementary material 4 (PDF 74 kb)
134_2019_5535_MOESM5_ESM.pdf (1.2 mb)
Supplementary material 5 (PDF 1258 kb)


  1. 1.
    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. CrossRefPubMedGoogle Scholar
  2. 2.
    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. CrossRefPubMedGoogle Scholar
  3. 3.
    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–R212CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    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:R31CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    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. CrossRefGoogle Scholar
  6. 6.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    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. CrossRefPubMedGoogle Scholar
  8. 8.
    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. CrossRefPubMedGoogle Scholar
  9. 9.
    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. CrossRefPubMedGoogle Scholar
  10. 10.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    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. CrossRefPubMedGoogle Scholar
  12. 12.
    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 2018Google Scholar
  13. 13.
    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 14:187–196CrossRefPubMedGoogle Scholar
  14. 14.
    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 270:2957–2963CrossRefPubMedGoogle Scholar
  15. 15.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829CrossRefPubMedGoogle Scholar
  16. 16.
    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. CrossRefGoogle Scholar
  17. 17.
    Wells GA, Shea B, OConnell D, et al (2000) The Newcastle–Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Accessed 01 Jan 2019
  18. 18.
    R Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Google Scholar
  19. 19.
    Schwarzer G (2015) Meta: general package for meta-analysis, R Package Version 4.3–2.
  20. 20.
    Gordon M, Lumley T (2017) forestplot: Advanced forest plot using “grid” graphics. R package version 1.7.
  21. 21.
    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
  22. 22.
    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
  23. 23.
    Cochran WG (2018) The combination of estimates from different experiments. Biometrics 10:101–129CrossRefGoogle Scholar
  24. 24.
    Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Sedgwick P (2015) Meta-analyses: what is heterogeneity? BMJ 350:h1435. CrossRefPubMedGoogle Scholar
  26. 26.
    Heegard KD, Stewart IJ, Cap AP et al (2015) Early acute kidney injury in military casualties. J Trauma Acute Care Surg 78:988–993. CrossRefPubMedGoogle Scholar
  27. 27.
    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. CrossRefPubMedGoogle Scholar
  28. 28.
    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. CrossRefPubMedGoogle Scholar
  29. 29.
    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. CrossRefPubMedGoogle Scholar
  30. 30.
    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. (discussion 66–7)CrossRefPubMedGoogle Scholar
  31. 31.
    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. CrossRefPubMedGoogle Scholar
  32. 32.
    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. CrossRefPubMedGoogle Scholar
  33. 33.
    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. CrossRefPubMedGoogle Scholar
  34. 34.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    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. CrossRefPubMedGoogle Scholar
  36. 36.
    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. CrossRefPubMedGoogle Scholar
  37. 37.
    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 40:485–492Google Scholar
  38. 38.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    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. CrossRefPubMedGoogle Scholar
  40. 40.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    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. (discussion 287–8)CrossRefPubMedGoogle Scholar
  42. 42.
    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. CrossRefPubMedGoogle Scholar
  43. 43.
    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. CrossRefPubMedGoogle Scholar
  44. 44.
    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. CrossRefPubMedGoogle Scholar
  45. 45.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    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. CrossRefPubMedGoogle Scholar
  48. 48.
    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. CrossRefPubMedGoogle Scholar
  49. 49.
    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. CrossRefPubMedGoogle Scholar
  50. 50.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    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. CrossRefPubMedGoogle Scholar
  55. 55.
    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. CrossRefPubMedGoogle Scholar
  56. 56.
    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. CrossRefPubMedGoogle Scholar
  57. 57.
    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 71:669–679CrossRefPubMedGoogle Scholar
  58. 58.
    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. CrossRefPubMedGoogle Scholar
  59. 59.
    Uchino S, Kellum JA, Bellomo R et al (2005) Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 294:813–818. CrossRefPubMedGoogle Scholar
  60. 60.
    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. CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    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.
  62. 62.
    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. CrossRefPubMedGoogle Scholar
  63. 63.
    Parikh A, Shaw A (2012) The economics of renal failure and kidney disease in critically ill patients. Crit Care Clin 28:99–111. vii CrossRefPubMedGoogle Scholar
  64. 64.
    Forni LG, Darmon M, Ostermann M et al (2017) Renal recovery after acute kidney injury. Intensive Care Med 43:855–866. CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Skaga NO, Eken T, Jones JM, Steen PA (2008) Different definitions of patient outcome: consequences for performance analysis in trauma. Injury 39:612–622. CrossRefPubMedGoogle Scholar
  66. 66.
    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. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anaesthesia and Intensive CareAkershus University HospitalLørenskogNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Medical Library at Ullevål HospitalUniversity of Oslo LibraryOsloNorway
  4. 4.Department of Anaesthesiology, Division of Emergencies and Critical CareOslo University Hospital UllevålOsloNorway
  5. 5.Division for Health ServicesNorwegian Institute of Public HealthOsloNorway
  6. 6.Center for Evidence Based PracticeWestern Norway University of Applied SciencesBergenNorway
  7. 7.Renal Research Group Ullevål, Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway

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