Incidence and risk factors of acute kidney injury in trauma patients in Zagazig University Hospital

Abstract

Background Acute kidney injury (AKI) is common in the ICU population with an incidence of 1–25%, depending on the criteria used for definition, and is associated with mortality rates of 50–70%. Few studies have evaluated the epidemiology of AKI in a population of trauma patients. The critically ill trauma patient sustains multiple insults to the kidney which include hypovolemic shock, hypothermia, direct urological organ injury, rhabdomyolysis, abdominal compartment syndrome, sepsis, and exposure to nephrotoxins such as contrast material and antimicrobials. AKI in trauma patients affect outcome that increases both morbidity and mortality. Patients and methods This study was conducted on 105 adult polytrauma patients in the emergency ICU at Zagazig University Hospital, who were polytrauma patients with exclusion of patients with history of chronic kidney disease, patients with history of diabetes and hypertension. The following data were recorded: demographic data (name, age, sex), data related to trauma (time between onset of trauma and hospital admission, time between onset of trauma and ICU admission, Glasgow Coma Scale, Injury Severity Score, type of trauma), data to detect AKI using RIFLE criteria (serum creatinine basal, peak and discharge and urine output estimation level). Serum neutrophil gelatinase-associated lipocalin level was detected in the first 24 h of trauma, data to detect risk factors (hemodynamics, nephrotoxic drugs, fluids used in resuscitation, coagulation profile, creatine kinase, complete blood count, intubation and mechanical ventilation, and data collected to detect the outcome (length of ICU stay, renal replacement therapy, and mortality). Results There were 53 (50.5%) patients developed AKI by RIFLE criteria. Within this population, patients were classified as 16 (15.2%) patients in the Risk stage; 25 (23.8%) patients in Injury stage, and 12 (11.4%) patients in Failure stage; however, no patients enter in loss of function or end-stage renal disease The risk factors of AKI were: rhabdomyolysis (CK>1000 IU/l) was found in 31 (58.5%) patients, sepsis in 23 (43.4%) cases, coagulopathy in 11 (20.8%) cases, and abdominal trauma in two (3.8%) cases and so there were statistically significant differences between AKI and no-AKI as regards rhabdomyolysis, coagulopathy, and sepsis as risk factors of developing AKI in trauma patients (P=0.000, 0.0001, and 0.001, respectively); however, among patients with AKI, only one patient takes contrast dye and develops AKI (P=0.32). There were statistically significant differences between AKI and no-AKI as regards need for blood transfusion, HCO3 resuscitation, diuretic intake, inotropic support, and crystalloid resuscitation (P=0.002, 0.001, 0.023, 0.000, 0.037, respectively) as risk factors of developing AKI in trauma patients. As regards outcome there were statistically significant increase in mortality in patients who develop AKI (P=0.03) increased mortality with increased severity of RIFLE class. Conclusion The incidence of AKI among trauma patients in emergency ICU in Zagzig University Hospital was 50.5%. AKI is a frequent and fatal complication after major trauma. Development of AKI is associated with increased mortality. The causes of AKI in trauma patients are multifactorial. Early detection of AKI and management of risk factors of AKI can improve the outcome.