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Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients.

ABSTRACT: To determine clinical and genomic characteristics and in-hospital mortality risk associated with acute kidney injury (AKI) in the multicenter prospective cohort of patients with blunt trauma.Less severe stages of AKI characterized by small changes in serum creatinine (sCr) are inadequately studied among trauma patients.We performed a secondary analysis of the "Inflammation and the Host Response to Injury" (Glue Grant) database to include adult blunt trauma patients without history of kidney disease. AKI was defined by the Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE) classification, which requires a 50% increase in sCr and stratifies patients into following 3 severity stages: risk, injury, and failure. Association between all stages of AKI and in-hospital mortality was analyzed using a multivariable logistic regression analysis. Genome-wide expression analysis was performed on whole blood leukocytes obtained within 12 hours of trauma.AKI occurred in 26% of 982 patients. The adjusted risk for hospital death was 3 times higher for patients with AKI compared with patients without AKI (odds ratio = 3.05) (95% confidence interval, 1.73-5.40). This risk was evident in a dose-response manner and even patients with mild AKI had odds ratio for dying of 2.57 (95% confidence interval, 1.19-5.50) compared with patients without AKI. Genome-wide expression analysis failed to show a significant number of genes whose expression could discriminate among patients with and without AKI.In a multicenter prospective cohort of blunt trauma patients, AKI characterized by small changes in sCr was associated with an independent risk of hospital death.

SUBMITTER: Bihorac A

PROVIDER: S-EPMC3357629 | biostudies-literature | 2010 Jul

REPOSITORIES: biostudies-literature

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Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients.

Bihorac Azra A Delano Matthew J MJ Schold Jesse D JD Lopez Maria Cecilia MC Nathens Avery B AB Maier Ronald V RV Layon Abraham Joseph AJ Baker Henry V HV Moldawer Lyle L LL

Annals of surgery 20100701 1

<h4>Objective</h4>To determine clinical and genomic characteristics and in-hospital mortality risk associated with acute kidney injury (AKI) in the multicenter prospective cohort of patients with blunt trauma.<h4>Summary background data</h4>Less severe stages of AKI characterized by small changes in serum creatinine (sCr) are inadequately studied among trauma patients.<h4>Methods</h4>We performed a secondary analysis of the "Inflammation and the Host Response to Injury" (Glue Grant) database to ...[more]

PMID: 20562612

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Project description:BackgroundAcute Kidney Injury (AKI) is a major and under-recognised cause of morbidity and mortality worldwide. Low and middle-income countries bear the greatest burden of AKI (85%). There is currently no published literature on AKI from the Pacific Islands. The aim of the present study was to report the incidence, aetiology, management and outcomes measures of AKI from the tertiary referral hospital of Samoa.Materials and methodsSingle-centre prospective observational study. Participants were recruited by the lead investigator from the hospital patient information system. The inclusion criteria for participation was (1) adults (>18 years) admitted to general wards of Tupua Tamasese Meaole (TTM) Hospital with a diagnosis of AKI between December 1, 2019 and May 31, 2020, and (2) serum creatinine level of >200 μmol/L, and (3) compliance with the current Kidney Disease Improving Global Outcomes (KDIGO) criteria for AKI diagnosis. The data collection form was adapted from the International Society for Nephrology - Global Snapshot Project, and recorded demographic and baseline characteristics, precipitating causes of AKI, treatment/management, and outcomes measures.ResultsThere was a total of 114 AKI admissions over the study period corresponding to a hospital-based AKI incidence of 26.8 per 1000 admissions per 6 months. 75% of AKI cases were community acquired. The leading causes of AKI were dehydration (79%) and sepsis (64%). More than 40% of cases presented with two or more Non-Communicable Disease co-morbidities. The in-patient mortality rate was 20.2%. In the 3 months following discharge from hospital, 25% of AKI cases had completely resolved, 25% of patients had died, and 18.7% of AKI cases had progressed to chronic kidney disease. The leading causes of mortality were cardiovascular events (35%) and sepsis (35%).ConclusionsThe hospital-based incidence and unfavourable outcomes of AKI are high in Samoa. Greater awareness of this under-recognised condition is warranted among the public, government officers, and health professionals.

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Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients.

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Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients.

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