Acute kidney injury and posttrauma multiple organ failure: the canary in the coal mine.
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.


CONCLUSIONS
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.


METHODS
I, prognostic study.
Department of Surgery, University of Colorado-Denver, CO 80204, USA.
Max V
MV
Wohlauer
Angela
A
Sauaia
Ernest E
EE
Moore
Clay Cothren
CC
Burlew
Anirban
A
Banerjee
Jeffrey
J
Johnson
D000208:Acute Disease; D000328:Adult; D016009:Chi-Square Distribution; D003120:Colorado / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007668:Kidney / Q000293:injuries*; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015996:Survival Rate