The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit.
OBJECTIVE
This study aimed to identify the incidence and outcomes of patients with trauma related acute kidney injury (AKI), as defined by RIFLE criteria, at a single level I trauma centre and trauma ICU.


METHODS
We performed a retrospective observational study of 666 patients admitted to a trauma ICU from a level I trauma unit from March 2008 to March 2011. We conducted multivariable logistic regression to identify independent predictors for AKI and mortality.


RESULTS
The overall incidence of AKI was 15% (n=102). Median injury severity score (ISS) was 25 (inter quartile range [IQR] 16-34) and mean age was 39 (SD 16.3) in the AKI group. Thirteen patients (13%) were referred with rhabdomyolysis associated renal Failure. Overall mortality in the AKI group was 57% (n=58) but was significantly lower in the rhabdomyolysis Failure group (23% versus 64%; p=0.012). AKI was independently associated with older age, base excess (BE)<-12 (odd ratio [OR] 22.9, 95% confidence interval [CI] 1.89-276.16), IV contrast administration (OR 2.7 95% CI 1.39-5.11) and blunt trauma (OR 2.2 95% CI 1.04-4.71). AKI was an independent predictor of mortality (OR 8.5, 95% CI 4.51-15.95). Thirty-nine (38%) patients required renal replacement therapy.


CONCLUSIONS
AKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low BE. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden.
Consultant Surgeon, Level I Trauma Unit and Trauma Intensive Care, Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa. Electronic address: drdavidskinner@gmail.com.
D L
DL
Skinner
T C
TC
Hardcastle
R N
RN
Rodseth
D J J
DJ
Muckart
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D016017:Odds Ratio; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
Acute kidney injury; Critical illness; Dialysis; Rhabdomyolysis; Trauma