Acute kidney injury in severe trauma assessed by RIFLE criteria: a common feature without implications on mortality?

Abstract

BackgroundAcute kidney injury (AKI) has been hard to assess due to the lack of standard definitions. Recently, the Risk, Injury, Failure, Loss and End-Stage Kidney (RIFLE) classification has been proposed to classify AKI in a number of clinical settings. This study aims to estimate the frequency and levels of severity of AKI and to study its association with patient mortality and length of stay (LOS) in a cohort of trauma patients needing intensive care.MethodsBetween August 2001 and September 2007, 436 trauma patients consecutively admitted to a general intensive care unit (ICU), were assessed using the RIFLE criteria. Demographic data, characteristics of injury, and severity of trauma variables were also collected.ResultsHalf of all ICU trauma admissions had AKI, which corresponded to the group of patients with a significantly higher severity of trauma. Among patients with AKI, RIFLE class R (Risk) comprised 47%, while I (Injury) and F (Failure) were, 36% and 17%, respectively. None of these patients required renal replacement therapy. No significant differences were found among these three AKI classes in relation to patient's age, gender, type and mechanism of injury, severity of trauma or mortality. Nevertheless, increasing severity of acute renal injury was associated with a longer ICU stay.ConclusionsAKI is a common feature among trauma patients requiring intensive care. Although the development of AKI is associated with an increased LOS it does not appear to influence patient mortality.

Factors Affecting Acute Renal Failure in Intensive Care Unit and Effect of These Factors on Mortality

“…24 The elongation of the ARF patients in intensive care unit was also reported by another study. 7 Similar to these studies in our study we demonstrated that in AKI group the duration of intensive care stay was 14.6±14.6 days. The stay was longer than non-AKI group.…”

“…Gomez et al reported 50% incidence for ARF in trauma patients and 24% for risk, 18% for injury and 37.8% for failure. 7 Park et al reported the incidence of ARF as 41.3 % on 378 patients. 24 The authors found 25 Cruz et al made a study on 2164 patients and reported 10.8% for ARF.…”

“…This classification system depends on the severity of illness and divided to Risk (class R), Injury (class I), Failure (class F), Loss (class F) and End-stage kidney disease (class E). [6][7][8] RIFLE system classificate the severity of AKI focused on changes of serum creatinine or urine output from the baseline condition. 6 RIFLE criteria is a simple and convenient classification for categorizing ARF and predict the likelihood of developing ARF.…”

Association of AKI with Adverse Outcomes in Burned Military Casualties

“…Recent work in the trauma, burn, and TBI populations is more relevant to our cohort. Although not universally demonstrated (24), AKI has been associated with increased mortality in trauma patients. Bihorac and colleagues (15) examined a cohort of 982 adults (average age, 41 years) with severe blunt trauma (82% had an ISS of .25) and found a 26% incidence of AKI by the RIFLE classification.…”

Acute Renal Injury in polytrauma patients

“…Em estudo observacional com cerca de 430 pacientes vítimas de politrauma, Gomes et al 3 demonstraram que 50% deles apresentavam IRA e que aqueles com maiores comprometimentos de função renal permaneciam mais tempo Acute Kidney Injury (AKI) in trauma is, in most cases, multifactorial. Factors related to the initial ressuscitation protocol, degree of the systemic inflamatory response to trauma, contrast nephropathy in diagnostic procedures, rhabdomyolysis and abdominal compartment syndrome are some of those factors.…”