A multi-center evaluation of early acute kidney injury in critically ill trauma patients.
BACKGROUND
Few studies have evaluated the epidemiology of acute kidney injury (AKI) in trauma.


OBJECTIVE
To evaluate the incidence, risk factors, and outcomes associated with early AKI (evident within 24 hours of admission) in critically ill trauma patients.


METHODS
A retrospective interrogation of prospectively collected data from the Australian New Zealand Intensive Care Society Adult Patient Database. A total of 9,449 trauma patients were admitted for >or=24 hours to 57 intensive care units across Australia from January 1(st), 2000, to December 31(st), 2005.


RESULTS
The crude incidence of AKI was 18.1% (n = 1,711). Older age, female sex (OR 1.60, 95% CI, 1.43-1.78, p < 0.0001), and the presence of co-morbid illness (OR 2.70, 95% CI 2.3-3.2, p < 0.0001) were associated with higher odds of AKI. Those with trauma not associated with brain injury (OR 2.40, 95% CI, 2.1-2.7, p < 0.0001) and a higher illness severity (OR 1.12, 95% CI, 1.11-1.12, p < 0.001) also had higher likelihood of AKI. Overall, AKI was associated with a higher crude mortality (16.7% vs. 7.8%, OR 2.36, 95% CI, 2.0-2.7, p < 0.001). Each RIFLE category of AKI was independently associated with hospital mortality in multi-variable analysis (risk: OR 1.69; injury OR 1.88; failure 2.29).


CONCLUSIONS
Trauma admissions to ICU are frequently complicated by early AKI. Those at high risk for AKI appear to be older, female, with co-morbid illnesses, and present with greater illness severity. Early AKI in trauma is also independently associated with higher mortality. These data indicate a higher burden of AKI than previously described.
Bagshaw
Sean M
SM
Division of Critical Care Medicine, Walter C. Mackenzie Centre, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada. bagshaw@ualberta.ca
George
Carol
C
Gibney
R T Noel
RT
Bellomo
Rinaldo
R
D018806:APACHE; D058186:Acute Kidney Injury / Q000401:mortality* / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D015984:Causality; D002423:Cause of Death; D015897:Comorbidity; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D016017:Odds Ratio; D011336:Probability; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014193:Trauma Centers; D014739:Victoria / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology*