title: African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a common source of morbidity after trauma. We sought to determine novel risk factors for AKI, by Acute Kidney Injury Network (AKIN) criteria, in critically ill trauma patients.
  
  
  METHODS
  A prospective cohort of 400 patients admitted to the intensive care unit of a level 1 trauma center was followed for the development of AKI over 5 days.
  
  
  RESULTS
  Acute kidney injury developed in 147 (36.8%) of 400 patients. In multivariable regression analysis, independent risk factors for AKI included African American race (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.08-3.18; P = .024), body mass index of 30 kg/m(2) or greater (OR, 4.72 versus normal body mass index; 95% CI, 2.59-8.61; P < .001), diabetes mellitus (OR, 3.26; 95% CI, 1.30-8.20; P = .012), abdominal Abbreviated Injury Scale score of 4 or more (OR, 3.78; 95% CI, 1.79-7.96; P < .001), and unmatched packed red blood cells administered during resuscitation (OR, 1.13 per unit; 95% CI, 1.04-1.23; P = .004). Acute Kidney Injury Network stages 1, 2, and 3 were associated with hospital mortality rates of 9.8%, 13.7%, and 30.4%, respectively, compared with 3.8% for those without AKI (P < .001).
  
  
  CONCLUSIONS
  Acute kidney injury in critically ill trauma patients is associated with substantial mortality. The findings of African American race, obesity, and blood product administration as independent risk factors for AKI deserve further study to elucidate underlying mechanisms.
authors.affiliation: Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. shashatm@mail.med.upenn.edu
authors.forename: Michael G S
authors.initials: MG
authors.lastname: Shashaty
authors.forename: Nuala J
authors.initials: NJ
authors.lastname: Meyer
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.forename: Robert
authors.initials: R
authors.lastname: Gallop
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.forename: Paul N
authors.initials: PN
authors.lastname: Lanken
authors.forename: Sandra
authors.initials: S
authors.lastname: Kaplan
authors.forename: Dilek
authors.initials: D
authors.lastname: Yarar
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kawut
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.forename: Jason D
authors.initials: JD
authors.lastname: Christie
mesh_terms: D015998:Abbreviated Injury Scale; D058186:Acute Kidney Injury / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D015992:Body Mass Index; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult