Acute kidney injury after trauma: Prevalence, clinical characteristics and RIFLE classification

Abreu, Krasnalhia Lívia S.; Silva, Geraldo Bezerra da; Barreto, Adller Gonçalves Costa; Melo, Fernanda Machado de; Oliveira, Bárbara B; Mota, Rosa Maria Salani; Rocha, Natália A.; Silva, Sônia L.; Araújo, Sônia Maria Holanda Almeida; Daher, Elizabeth De Francesco

doi:10.4103/0972-5229.74170

Cited by 65 publications

(54 citation statements)

References 56 publications

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“…These findings contrast with other forms of trauma-associated AKI, where authors have reported mortality rates ranging from 28% to 100%. [11][12][13] Other studies examining mortality from all causes of rhabdomyolysis report rates of 5 -24%. [6,8,14] …”

Section: Discussionmentioning

confidence: 99%

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

et al. 2017

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Background. Crush injury secondary to sjambok beatings is a well-described phenomenon in southern Africa. Owing to a number of factors, it can result in acute kidney injury (AKI). In 1992, Muckart et al. described a risk stratification system using venous bicarbonate (VB) that can be used in the management of these patients. Objective. To validate this score in the modern era of AKI risk stratification. Methods. A retrospective study was performed on a local trauma database from June 2010 to December 2012. All patients with crush injury from sjambok/blunt instrument beatings were included in the analysis. VB was compared with the Kidney Disease Improving Global Outcomes scoring system for AKI. Serum base excess (BE) and creatine kinase were also examined as biomarkers. The endpoints were the need for renal replacement therapy (RRT) and mortality. Results. Three hundred and ten patients were included. The overall mortality rate was 1.9%, 14.8% of patients had AKI, and 3.9% required RRT. Both VB and BE performed well in RRT prediction, with areas under the receiver operating characteristic curve of 0.847 (95% confidence interval (CI) 0.756 -0.938; p<0.001) and 0.871 (95% CI 0.795 -0.947; p<0.001), respectively. The sensitivity and specificity of BE were 83.3% and 80.2% at an optimal cut-point of -7.25 mmol/L, while those of VB were 83.3% and 79.5% at an optimal cut-point of 18.85 mmol/L. VB was significantly different across the AKI risk groups (p<0.001), in keeping with the original Muckart risk stratification system. Conclusion. The risk stratification score using VB is valid and should continue to be used as a tool in the management of patients with sjambok injuries. BE performs well in predicting the need for RRT, with a value of <-7.25 mmol/L indicating severe injury.

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Section: Discussionmentioning

confidence: 99%

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

et al. 2017

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“…Understanding the onset characteristics of AKI and the risk factors associated with its prognosis will improve the clinical prevention and treatment of AKI. Previous epidemiological studies on AKI often concentrate on single disease or intensive care units [2,3,4]; moreover, the applied AKI standards are different [5,6,7] and not all hospitalized patients are covered and so the sampling error exists; some studies only observe the hospitalized AKI patients whose serum creatinine (Scr) exceeds the normal range, while the patients at early stage whose Scr obviously increases but is still within the normal range [8] are ignored.…”

Section: Introductionmentioning

confidence: 99%

Survey of Acute Kidney Injury and Related Risk Factors of Mortality in Hospitalized Patients in a Third-Level Urban Hospital of Shanghai

Lu¹,

Muciño-Bermejo²,

Armignacco³

et al. 2014

Blood Purif

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Objective: The main aim of this study is to investigate the incidence and prognosis of acute kidney injury (AKI) and to clarify the risk factors associated with the prognosis of AKI in hospitalized patients. Method: All patients hospitalized from January 1st to December 31st 2012 in Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University were screened by the Lab Administration Network. All the patients with an intact medical history of AKI according to the Acute Kidney Injury Network (AKIN) were enrolled in the study cohort. AKI's incidence and etiology, as well as the patient's characteristics and prognosis, were retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors on the patient prognosis and renal outcome. Results: 934 AKI patients were enrolled. The incidence of AKI in hospitalized patients was 2.41%. The ratio of males to females of patients was 1.88:1 and the mean age was 60.82 w 16.94. The incidence of AKI increased with increase in age. Among hospitalized patients, 63.4% were from the surgical department, 35.4% from the internal medicine department, and 1.2% from the obstetric and gynecologic department. Regarding the cause of AKI, pre-renal AKI, acute tubular necrosis (ATN), acute glomerulonephritis and vasculitis (AGV), acute interstitial nephritis (AIN), and post-renal AKI contributed with 51.7, 37.7, 3.8, 3.5, and 3.3%, respectively. The survival rate on the day 28 after AKI was 71.8%. In addition, 65.7% patients got complete renal recovery, while 16.9% got partial renal recovery and 17.4% got renal loss. The mortality of AKI in hospitalized patients at Stage I, Stage II and Stage III was 24.8, 31.2 and 43.7%, respectively. Multivariate Logistic regression analysis showed that use of nephrotoxic drugs, [Odds Ratio (OR) = 2.313], hypotension in the previous week (OR = 4.482), oliguria (OR = 5.267), the number of extra-renal organ failures (OR = 1.376), and need for renal replacement therapy (RRT) (OR = 4.221) were independent risk factors for mortality. The number of extra-renal organ failures (OR = 1.529) and RRT (OR = 2.117) were independent risk factors for renal loss. Conclusion: AKI is one of the most common complications in hospitalized patients. The mortality is high and renal prognosis is poor after AKI. The prognosis is closely associated with the severity of AKI. Nephrotoxic drugs, hypotension within the last week, oliguria, the number of extra-renal organ failures, and RRT are independent risk factors for mortality, while the number of extra-renal organ failures and RRT are independent risk factors for renal loss. i 2014 S. Karger AG, Basel

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“…In particular, colloids resulted in an increase in acute kidney injury among patients with sepsis; conversely, they were protective against such injury in patients with traumatic injuries. This is scientifically plausible as trauma is characterized by volume loss leading to hypotension and renal ischaemia, resulting in acute kidney injury. Administration of colloid in injured patients rapidly increases systemic BP and improves renal perfusion.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of colloids versus crystalloids in critically ill, trauma and surgical patients

Qureshi

Rizvi

Patel

et al. 2016

Journal of British Surgery

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Acute kidney injury after trauma: Prevalence, clinical characteristics and RIFLE classification

Cited by 65 publications

References 56 publications

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

Survey of Acute Kidney Injury and Related Risk Factors of Mortality in Hospitalized Patients in a Third-Level Urban Hospital of Shanghai

Meta-analysis of colloids versus crystalloids in critically ill, trauma and surgical patients

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