Associated risk factors and outcomes of acute kidney injury in severe trauma: Results from the Spanish trauma ICU registry (RETRAUCI) - 19/08/20

Doi : 10.1016/j.accpm.2019.11.003

Mario Chico-Fernández ^a,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Jesús Abelardo Barea-Mendoza ^a,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Txoan Ormazabal-Zabala ^b,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Gerard Moreno-Muñoz ^c,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Diego Pastor-Marcos ^d,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Ana Bueno-González ^e,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Alberto Iglesias-Santiago ^f,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Maria Ángeles Ballesteros-Sanz ^g,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Jon Pérez-Bárcena ^h,^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}, Juan Antonio Llompart-Pou ^h,⁎, ^{^{1
On behalf of the Neurointensive Care and Trauma Working Group of the Spanish Society of Intensive Care Medicine (SEMICYUC).}}
^a UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, Spain
^b Servicio de Medicina Intensiva, Hospital Universitario de Donostia, Donostia, Spain
^c Servicio de Medicina Intensiva, Hospital Joan XXIII, Tarragona, Spain
^d Servicio de Medicina Intensiva, Hospital Universitario Lucus Augusti, Lugo, Spain
^e Servicio de Medicina Intensiva, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
^f Servicio de Medicina Intensiva, UCI Neurotraumatológica, Hospital Virgen de las Nieves, Granada, Spain
^g Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
^h Servei de Medicina Intensiva, Hospital Universitari Son Espases, Institut d’Investigació Sanitària Illes Balears (IdISBa), Carretera Valldemossa, 79, 07120 Palma, Spain

^⁎Corresponding author.

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Highlights

•	Acute kidney injury was common in our large sample of trauma ICU patients.
•	Age, haemodynamic instability, coagulopathy, rhabdomyolysis and AIS abdomen>3 were associated risk factors to acute kidney injury.
•	Acute kidney injury was associated with mortality after adjustment by age, sex and severity of injury.

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Abstract

Introduction

Acute kidney injury (AKI) constitutes a common complication after severe trauma. Our objective was to analyse the associated risk factors and outcomes of AKI in a large, multicentre sample of trauma ICU patients.

Materials and methods

Observational, prospective and multicentre nationwide registry (RETRAUCI). We included all patients admitted to the participating ICUs from November 2013 to May 2017. We analysed the impact of AKI evaluated by the Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE) definition. Comparison of groups was performed using Wilcoxon test, Chi-Square Test or Fisher's exact test as appropriate. A multiple logistic regression analysis was performed to analyse associated factors to the development of AKI. Logistic regression was used to calculate AKI-related mortality. A P value<0.05 was considered significant.

Results

During the study period, 5882 trauma patients were admitted. Complete data were available for 5740 patients. Among them, 871 had AKI (15.17%), distributed by RIFLE R 458 (7.98%), RIFLE I 234 (4.08%) and RIFLE F 179 (3.12%). Associated risk factors were: age (OR 3.05), haemodynamic instability (OR 2.90 to OR 8.34 depending on the severity of hypotension), coagulopathy (OR 1.82), rhabdomyolysis (OR 4.67) and AIS abdomen (OR 1.54). AKI was associated with mortality (crude OR 1.93 (1.59-2.36)), even after adjusting by potential confounders (adjusted OR 1.40 (1.13-1.73)).

Conclusion

In our large sample of trauma ICU patients we found an incidence of AKI of 15%, which was associated with an increased mortality.

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Keywords : Severe trauma, Acute kidney injury, Intensive care, Outcomes, Mortality

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Vol 39 - N° 4

P. 503-506 - août 2020 Regresar al número

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Associated risk factors and outcomes of acute kidney injury in severe trauma: Results from the Spanish trauma ICU registry (RETRAUCI) - 19/08/20

Highlights

Abstract

Introduction

Materials and methods

Results

Conclusion

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