Risk factors for injury acute renal in patients with severe trauma and its effect on mortality

Baitello, André Luciano; Marcatto, Gustavo; Yagi, Roberto Kaoru

doi:10.5935/0101-2800.20130021

Cited by 14 publications

(13 citation statements)

References 17 publications

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“…[ 39 40 41 42 43 44 ] TBI triggers a series of catabolic processes that lead to reduced glomerular filtration and developing AKI that is further worsened by reduced renal perfusion pressure secondary to hypovolemia and shock. [ 42 45 ] Seventy-six percent deaths have been reported in these patients in TBI,[ 37 41 ] which is almost similar to our results (83.3% deaths). In our study, the risk of mortality increased by 24.7 times in TBI patients who developed AKI.…”

Section: Discussionsupporting

confidence: 90%

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Non- Neurological Complications after Traumatic Brain Injury: A Prospective Observational Study

Goyal

Hazarika

Khandelwal

et al. 2018

Indian Journal of Critical Care Medicine

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Introduction and Aims:Recognizing and treating nonneurological complications occurring in traumatic brain injury (TBI) patients during intensive care unit (ICU) stay are challenging. The aim is to estimate various nonneurological complications in TBI patients. The secondary aim is to see the effect of these complications on ICU stay, disability, and mortality.Materials and Methods:This was a prospective observational study at the neuro-ICU of a Level-I trauma center. A total of 154 TBI patients were enrolled. The period of the study was from admission to discharge from ICU or demise. Inclusion criteria were patients aged >16 years and patients with severe TBI (Glasgow coma score [GCS] ≤8). Nonneurological complications were frequent in TBI patients.Results:We observed respiratory complications to be the most common (61%). Other complications, in the decreasing order, included dyselectrolytemia (46.1%), cardiovascular (34.4%), coagulopathy (33.1%), sepsis (26%), abdominal complications (17.5%), and acute kidney injury (AKI, 3.9%). The presence of systemic complications except AKI was found to be significantly associated with increased ICU stay. Most of the patients of AKI died early in ICU. Respiratory dysfunction was found to be independently associated with 3.05 times higher risk of worsening clinical condition (disability) (P < 0.018). The presence of cardiovascular complications during ICU stay (4.2 times, P < 0.005), AKI (24.7 times, P < 0.02), coagulopathy (3.13 times, P < 0.047), and GCS <6 (4.2 times, P < 0.006) of TBI was independently associated with significantly increased risk of ICU mortality.Conclusion:TBI patients tend to have poor outcome due to concomitant nonneurological complications. These have significant bearing on ICU stay, disability, and mortality.

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Section: Discussionsupporting

confidence: 90%

“…The incidence of AKI following trauma is reported from 0.098% to 17.3%. [ 7 36 37 38 39 40 ] The incidence of AKI in our study was 3.5%, while in Corral et al . 's study, it was 8%.…”

Section: Discussioncontrasting

confidence: 46%

Non- Neurological Complications after Traumatic Brain Injury: A Prospective Observational Study

Goyal

Hazarika

Khandelwal

et al. 2018

Indian Journal of Critical Care Medicine

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“…After incorporation of currently available methods of classification, such as KDIGO, RIFLE and AKIN (all three based on creatinine changes and/or decrease of urine output), the overall incidence of 32.9% of AKI in our study is within the range of 16% to 39% found in the literature [ 10 , 11 ]. When looking separately at the incidence of AKI among trauma and non-trauma cases, the incidence of 36.6% among non-trauma patients is within the range shown above, although the AKI incidence of 28.6% among trauma patients is above the range of 6% to 17.3% found in the literature [ 6 , 12 , 13 ]. An explanation could be that trauma patients were more often severely ill, according to their higher APACHE II score compared to non-trauma cases.…”

Section: Discussionmentioning

confidence: 72%

Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study

Santos

Monteiro

2015

BMC Nephrol

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BackgroundAcute kidney injury (AKI) is common among intensive care unit (ICU) patients and is associated with high mortality. Type of ICU, category of admission diagnosis, and socioeconomic characteristics of the region can impact AKI outcomes. We aimed to determine incidence, associated factors and mortality of AKI among trauma and non-trauma patients in a general ICU from a low-income area.MethodsWe studied 279 consecutive patients in an ICU during a follow-up of one year. Patients with less than 24-hour stay in the ICU and with chronic kidney disease were excluded. AKI was classified according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria in three stages. Comparisons were performed by the Student-t and Mann–Whitney tests for continuous variables, respectively with and without normal distribution. Comparisons of frequencies were carried out by the Fisher test. Multivariate logistic regression was used to test variables as predictors for AKI and death.ResultsAdmission categories were proportionally divided into 51.6% of non-trauma diagnosis and 48.4% of trauma cases. Most trauma cases involved brain injury (79.5%). The overall incidence of AKI was 32.9%, distributed among the three stages: 33.7% stage 1, 29.4% stage 2 and 36.9% stage-3. Patients who developed AKI were older, had more diabetes, stayed longer in the ICU, presented higher APACHE II and more often needed mechanical ventilation and use of vasopressors. In comparison with non-trauma cases, trauma patients had a greater prevalence of males, higher APACHE II score, higher urine output, and younger age. There was no difference concerning development of AKI and crude mortality between trauma and non-trauma patients. Age, presence of diabetes, APACHE score and use of vasopressors were independent predictors for AKI, and AKI increased the risk of death ten-fold (OR = 14.51; CI 95% = 7.94-26.61; p < 0.001).ConclusionsThere was a high incidence of AKI in this study. AKI was strongly associated with mortality both among trauma and non-trauma patients. Trauma cases, especially brain injury due to traffic accidents involving motorized two-wheeled vehicles, should be seen as an important preventable cause of AKI.

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“…Acute inpatient dialysis was found to be an inpatient variable predictive of tracheostomy and may serve as a marker of severity for non-neurological injuries. Although effects on tracheostomy have not been reported, acute kidney injury is a common complication in TBI patients with rates ranging from 9.2 to 23% [26][27][28][29]. Further work is needed to elucidate the relationship between the requirement for dialysis and tracheostomy, but fluid overload may play an important role.…”

Section: Discussionmentioning

confidence: 99%

Inpatient Complications Predict Tracheostomy Better than Admission Variables After Traumatic Brain Injury

et al. 2018

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Background: Data regarding who will require tracheostomy are lacking which may limit investigations into therapeutic effects of early tracheostomy. Methods:We performed an observational study of adult traumatic brain injury (TBI) patients requiring intensive care unit (ICU) admission for ≥ 72 h and mechanical ventilation for ≥ 24 h between January 2014 and December 2014 at a level 1 trauma center. Patients who had life-sustaining measures withdrawn were excluded. Multivariable logistic regression analyses were used to assess admission and inpatient factors associated with receiving a tracheostomy and to develop predictive models. Inpatient complications prior to day 7 were used to standardize data collection for patients with and without tracheostomy. Patients who received tracheostomy prior to day 7 were excluded from analysis.Results: In total, 209 patients (78% men, mean 48 years old, median Glasgow Coma Scale score (GCS) 8) met study criteria with tracheostomy performed in 94 (45%). Admission predictors of tracheostomy included GCS, chest tube, Injury Severity Score, and Marshall score. Inpatient factors associated with tracheostomy included the requirement for an external ventricular drain (EVD), number of operations, inpatient dialysis, aspiration, GCS on day 5, and reintubation. Multiple logistic regression analysis demonstrated that the number of operation room trips (adjusted odds ratio [AOR], 1.75; 95% CI, 1.04-2.97; P = 0.036), reintubation (AOR, 8.45; 95% CI, 1.91-37.44; P = .005), and placement of an EVD (AOR, 3.48; 95% CI, 1.27-9.58; P = .016) were independently associated with patients undergoing tracheostomy. Higher GCS on hospital day 5 (AOR, 0.52; 95% CI, 0.40-0.68; P < 0.001) was protective against tracheostomy. A model of inpatient variables only had a stronger association with tracheostomy than one with admission variables only (ROC AUC 0.93 vs 0.72, P < 0.001) and did not benefit from the addition of admission variables (ROC AUC 0.93 vs 0.92, P = 0.78). Conclusion:Potentially modifiable inpatient factors have a stronger association with tracheostomy than do admission characteristics. Multicenter studies are needed to validate the results.

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Risk factors for injury acute renal in patients with severe trauma and its effect on mortality

Abstract: The identification of these risk factors is of paramount importance for the development of care strategies for patients suffering from severe trauma, for the prevention of acute kidney injury and the associated high mortality.

Cited by 14 publications

References 17 publications

Non- Neurological Complications after Traumatic Brain Injury: A Prospective Observational Study

Non- Neurological Complications after Traumatic Brain Injury: A Prospective Observational Study

Acute kidney injury in an intensive care unit of a general hospital with emergency room specializing in trauma: an observational prospective study

Inpatient Complications Predict Tracheostomy Better than Admission Variables After Traumatic Brain Injury

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