The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit

Abstract

PurposeThis study aimed to identify the incidence and outcomes of patients with trauma related acute kidney injury (AKI), as defined by RIFLE criteria, at a single level I trauma centre and trauma ICU. MethodsWe performed a retrospective observational study of 666 patients admitted to a trauma ICU from a level I trauma unit from March 2008 to March 2011. We conducted multivariable logistic regression to identify independent predictors for AKI and mortality. ResultsThe overall incidence of AKI was 15% (n=102). Median injury severity score (ISS) was 25 (inter quartile range [IQR] 16–34) and mean age was 39 (SD 16.3) in the AKI group. Thirteen patients (13%) were referred with rhabdomyolysis associated renal Failure. Overall mortality in the AKI group was 57% (n=58) but was significantly lower in the rhabdomyolysis Failure group (23% versus 64%; p=0.012). AKI was independently associated with older age, base excess (BE)<−12 (odd ratio [OR] 22.9, 95% confidence interval [CI] 1.89–276.16), IV contrast administration (OR 2.7 95% CI 1.39–5.11) and blunt trauma (OR 2.2 95% CI 1.04–4.71). AKI was an independent predictor of mortality (OR 8.5, 95% CI 4.51–15.95). Thirty-nine (38%) patients required renal replacement therapy. ConclusionsAKI in critically ill trauma patients is an independent risk factor for mortality and is independently associated with increasing age and low BE. Renal replacement therapy utilisation is high in this group and represents a significant health care cost burden.