title: Acute Kidney Injury in Critically Injured Combat Veterans: A Retrospective Cohort Study.
abstract: BACKGROUND
  Acute kidney injury (AKI) has been associated with mortality after traumatic injury. However, there is a paucity of data for military service members with injuries received in combat. We sought to identify risk factors for AKI after combat trauma and evaluate whether AKI is a predictor of mortality.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  US service members who were critically wounded in Iraq or Afghanistan from February 1, 2002, to February 1, 2011, and survived until evacuation to Landstuhl Regional Medical Center, Germany.
  
  
  METHODS
  Demographic variables, vital signs, injury severity score, presence of burn injury, and mechanism of injury as defined at the time of initial injury, as well as the presence of AKI ascertained within the first 7 days using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine criteria.
  
  
  RESULTS
  Logistic regression models were used to identify risk factors for both AKI and death.
  
  
  RESULTS
  Of 6,011 records, 3,807 were included for analysis after excluding patients with missing data. AKI occurred in 474 (12.5%) patients and 112 (2.9%) died. More patients with versus without AKI died (n=62 [13.1%] vs n=50 [1.5%]; P<0.001). After adjustment, AKI was a predictor of mortality (OR, 5.14; 95% CI, 3.33-7.93; P<0.001). Predictors of AKI were age, African American race, injury severity score, amputations, burns, and presenting vital signs.
  
  
  CONCLUSIONS
  AKI diagnoses limited to creatinine-based definitions.
  
  
  CONCLUSIONS
  AKI predicted mortality in combat veterans injured in the wars in Iraq and Afghanistan.
authors.affiliation: David Grant Medical Center, Clinical Investigation Facility, Travis Air Force Base, CA; Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: ian.stewart@us.af.mil.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Stewart
authors.affiliation: Uniformed Services University of the Health Sciences, Bethesda, MD; San Antonio Military Medical Center, Fort Sam Houston, TX.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Sosnov
authors.affiliation: US Army Institute of Surgical Research, Fort Sam Houston, TX.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Howard
authors.affiliation: Uniformed Services University of the Health Sciences, Bethesda, MD; US Army Institute of Surgical Research, Fort Sam Houston, TX.
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D014728:Veterans; D014947:Wounds and Injuries / Q000150:complications*
keywords: Acute kidney injury (AKI); KDIGO AKI criteria; burn injury; combat; combat veteran; death; military personnel; military service; mortality; risk factors; serum creatinine; trauma; war casualty