186 Acute Kidney Injury in Skeletal Trauma Admissions to Intensive Care: An Under-Estimated Complication

Abstract Introduction Acute kidney injury (AKI) is associated with prolonged admission and 3.5 times increased mortality for trauma patients requiring intensive care (ICU) treatment. Blunt trauma confers greater risk of AKI than penetrating trauma, potentially related to long bone fracture. The relationship between skeletal trauma and AKI in ICU has not previously been investigated. Method Retrospective data was analysed from 202 consecutive adult patients admitted to ICU with skeletal trauma from 01/06/2018 to 01/06/2019. AKI was defined by creatinine rise >1.5 times baseline. Results AKI was found in 70/202 (34.65%) patients aged 16-99 years, 138 males and 64 females. Mean limb Abbreviated Injury Scale (AIS) was significantly higher in AKI (AIS= 2.57 (SD 0.53) versus non-AKI AIS=2.38 (SD 0.61), p = 0.027). Other body regions and total Injury Severity Score (ISS) were non-significant. AKI was associated with a significantly worse Glasgow Outcome Score (AKI 3.28 (SD 1.52) versus 4.02 (SD 1.08) p < 0.001), increased intensive care stay (AKI 7.03 (SD 8.30) days versus non-AKI 3.8 (SD 4.1) days p < 0.001) and increased 30-day mortality (AKI 18/70 (25.71%) versus non-AKI 10/132 (7.58%) p < 0.001) Conclusions Skeletal trauma patients have a high incidence of AKI, which was significantly correlated with severity of skeletal limb trauma but not overall ISS.

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Emergency angiography for trauma patients and potential association with acute kidney injury

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00400-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ryo Yamamoto ◽

Ramon F. Cestero ◽

Jo Yoshizawa ◽

Katsuya Maeshima ◽

Junichi Sasaki

Keyword(s):

Acute Kidney Injury ◽

Propensity Score ◽

Propensity Score Matching ◽

Injury Severity ◽

Vital Signs ◽

Kidney Injury ◽

Trauma Patients ◽

Potential Association ◽

Trauma Surgeons ◽

Injured Patients

Abstract Background Angiography has been conducted as a hemostatic procedure for trauma patients. While several complications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. To elucidate whether emergency angiography would introduce kidney dysfunction in trauma victims, we compared the incidence of AKI between patients who underwent emergency angiography and those who did not. Methods A retrospective cohort study was conducted using a nationwide trauma database (2004–2019), and adult trauma patients were included. The indication of emergency angiography was determined by both trauma surgeons and radiologists, and AKI was diagnosed by treating physicians based on a rise in serum creatinine and/or fall in urine output according to any published standard criteria. Incidence of AKI was compared between patients who underwent emergency angiography and those who did not. Propensity score matching was conducted to adjust baseline characteristics including age, comorbidities, mechanism of injury, vital signs on admission, Injury Severity Scale (ISS), degree of traumatic kidney injury, surgical procedures, and surgery on the kidney, such as nephrectomy and nephrorrhaphy. Results Among 230,776 patients eligible for the study, 14,180 underwent emergency angiography. The abdomen/pelvis was major site for angiography (10,624 [83.5%]). Embolization was performed in 5,541 (43.5%). Propensity score matching selected 12,724 pairs of severely injured patients (median age, 59; median ISS, 25). While the incidence of AKI was rare, it was higher among patients who underwent emergency angiography than in those who did not (140 [1.1%] vs. 67 [0.5%]; odds ratio = 2.10 [1.57–2.82]; p < 0.01). The association between emergency angiography and subsequent AKI was observed regardless of vasopressor usage or injury severity in subgroup analyses. Conclusions Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.

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External Validation for Acute Kidney Injury Severity Scores: A Multicenter Retrospective Study in 14 Japanese ICUs

American Journal of Nephrology ◽

10.1159/000439118 ◽

2015 ◽

Vol 42 (1) ◽

pp. 57-64 ◽

Cited By ~ 10

Author(s):

Tetsu Ohnuma ◽

Shigehiko Uchino ◽

Noriyoshi Toki ◽

Kenta Takeda ◽

Yoshitomo Namba ◽

...

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Injury Severity ◽

Characteristic Curve ◽

External Validation ◽

Kidney Injury ◽

Receiver Operator Characteristic Curve ◽

Saps Ii ◽

Severity Scores ◽

Saps Ii Score

Background/Aims: Acute kidney injury (AKI) is associated with high mortality. Multiple AKI severity scores have been derived to predict patient outcome. We externally validated new AKI severity scores using the Japanese Society for Physicians and Trainees in Intensive Care (JSEPTIC) database. Methods: New AKI severity scores published in the 21st century (Mehta, Stuivenberg Hospital Acute Renal Failure (SHARF) II, Program to Improve Care in Acute Renal Disease (PICARD), Vellore and Demirjian), Liano, Simplified Acute Physiology Score (SAPS) II and lactate were compared using the JSEPTIC database that collected retrospectively 343 patients with AKI who required continuous renal replacement therapy (CRRT) in 14 intensive care units. Accuracy of the severity scores was assessed by the area under the receiver-operator characteristic curve (AUROC, discrimination) and Hosmer-Lemeshow test (H-L test, calibration). Results: The median age was 69 years and 65.8% were male. The median SAPS II score was 53 and the hospital mortality was 58.6%. The AUROC curves revealed low discrimination ability of the new AKI severity scores (Mehta 0.65, SHARF II 0.64, PICARD 0.64, Vellore 0.64, Demirjian 0.69), similar to Liano 0.67, SAPS II 0.67 and lactate 0.64. The H-L test also demonstrated that all assessed scores except for Liano had significantly low calibration ability. Conclusions: Using a multicenter database of AKI patients requiring CRRT, this study externally validated new AKI severity scores. While the Demirjian's score and Liano's score showed a better performance, further research will be required to confirm these findings.

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Computed Tomography with Intravenous Contrast is Not Associated with Development of Acute Kidney Injury in Severely Injured Pediatric Patients

The American Surgeon ◽

10.1177/000313481908500101 ◽

2019 ◽

Vol 85 (1) ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Paul K. McGaha ◽

Jeremy Johnson ◽

Tabitha Garwe ◽

Zoona Sarwar ◽

Prasenjeet Motghare ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ct Scan ◽

Injury Severity ◽

Pediatric Trauma ◽

Kidney Injury ◽

Trauma Patients ◽

Severely Injured ◽

Intravenous Contrast ◽

Trauma Population ◽

Significant Difference

Data for the incidence of acute kidney injury (AKI) related to intravenous contrast administration in the pediatric trauma population are limited. Obtaining a creatinine value before elective CT scans is a relatively accepted standard of care. We sought to determine whether there was any significant difference in the incidence of AKI between severely injured patients who received IV contrast and those who did not. We reviewed data from the trauma registry at our Level I pediatric trauma center. We limited the patients to severely injured pediatric traumas (<15 years old) directly transported from the scene of injury with a creatinine level measured on arrival. Two hundred and eleven patients were included in the study. AKI was defined by the criteria of the AKI Network. We then compared incidence of AKI in those who received a CT scan with IV contrast with those who did not receive IV contrast. The two groups were comparable in age, gender, Glasgow Coma Scale, Injury Severity Score, mean creatinine on arrival, and mean creatinine post–CT scan/arrival. There was no significant difference in AKI between the two. In a subgroup analysis of patients presenting in shock, there was no significant difference in AKI. Our study suggests that IV contrast is not associated with the development of AKI in severely injured pediatric trauma patients. Although obtaining a creatinine value before exposure is ideal, a CT scan with IV contrast in severely injured children should not be delayed to obtain a creatinine value.

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Ketorolac Use for Pain Management in Trauma Patients With Rib Fractures Does not Increase of Acute Kidney Injury or Incidence of Bleeding

The American Surgeon ◽

10.1177/0003134820954835 ◽

2020 ◽

pp. 000313482095483

Author(s):

Julia Torabi ◽

Jody M. Kaban ◽

Erin Lewis ◽

Dana Laikhram ◽

Rachel Simon ◽

...

Keyword(s):

Acute Kidney Injury ◽

Pain Management ◽

Injury Severity ◽

Kidney Injury ◽

Rib Fractures ◽

Rib Fracture ◽

Trauma Patients ◽

Bleeding Events ◽

Transfusion Requirements ◽

Intravenous Ketorolac

Introduction Ketorolac is useful in acute pain management to avoid opiate-related complications; however, some surgeons fear associated acute kidney injury (AKI) and bleeding despite a paucity of literature on ketorolac use in trauma patients. We hypothesized that our institution's use of intravenous ketorolac for rib fracture pain management did not increase the incidence of bleeding or AKI. Methods Rib fracture patients aged 15 years and above admitted between January 2016-June 2018 were identified in our trauma registry along with frequency of bleeding events. AKI was defined as ≥ 1.5x increase in serum creatinine from baseline measured on the second day of admission (after 24 hours of resuscitation) or an increase of ≥ .3 mg/dL over a 48-hour period. Patients receiving ketorolac were compared to patients with no ketorolac use. Results Two cohorts of 199 control and 205 ketorolac patients were found to be similar in age, gender, admission systolic blood pressure (SBP), injury severity score, intravenous radiocontrast received, and transfusion requirements. Analysis revealed no difference in frequency of AKI using both definitions (8% vs. 7.3%, P = .79) and (19.6% vs. 15.1%, P = .24), respectively, or bleeding events (2.5% vs. 0%, P = .03). Logistic regression demonstrated that ketorolac use was not an independent predictor for AKI but age and admission SBP < 90 were. Conclusion Use of ketorolac in this cohort of trauma patients with rib fractures did not increase the incidence of AKI or bleeding events.

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A RETROSPECTIVE ANALYSIS OF CUMULATIVE FLUID BALANCE AND ITS EFFECT ON RECOVERY IN PATIENTS WITH WHIPPLES SURGERY.

10.36106/ijar/2614640 ◽

2021 ◽

pp. 51-54

Author(s):

Neha Garg ◽

Gaurav Sindhwani ◽

Samba Siva Rao Pasupuleti ◽

Raghini Kalimbi

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Retrospective Analysis ◽

Kidney Injury ◽

Primary Objective ◽

Bivariate Analysis ◽

Long Duration ◽

Intensive Care Stay ◽

Duration Of Surgery ◽

Secondary Objective

Introduction- Large amount of uid is administered in whipples owing to its long duration of surgery and major resection of pancreas and gastrointestinal structures. Excessive uid may lead to cellular swelling ,disruption of renal architecture and tension in the renal capsule leading to AKI. Thus the primary objective of the study was to study the effect of positive cumulative uid balance on development of postoperative Acute kidney injury (AKI) and length of intensive care stay (ICU). Secondary objective was to nd the effect of positive uid balance on development of sepsis and surgical complications. Methodology- A retrospective analysis was conducted in 106 patients undergoing whipples surgery. Results-Cumulative uid balance in rst 24 hours was 6.5 ± 1.9 litres. Acute kidney injury occurred in 20.6% of patients. On bivariate analysis, older age, longer duration of surgery and the highest lactate were found to be statistically signicantly associated with the development of acute kidney injury. The same factors were also found signicant in the multivariate analysis for development of AKI. Conclusion- Increased positive cumulative uid balance at 24 hours did not increase the development of AKI or increased the length of intensive care stay in patients undergoing whipples surgery .

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Daily hemodialysis is cost-effective for intensive care patients with acute kidney injury

PsycEXTRA Dataset ◽

10.1037/e504342010-020 ◽

2009 ◽

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Injury ◽

Cost Effective ◽

Intensive Care Patients ◽

Daily Hemodialysis

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Expression of HO1 and PER2 can predict the incidence of delirium in trauma patients with concomitant brain injury

Scientific Reports ◽

10.1038/s41598-021-94773-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Matti Steimer ◽

Sandra Kaiser ◽

Felix Ulbrich ◽

Johannes Kalbhenn ◽

Hartmut Bürkle ◽

...

Keyword(s):

Brain Injury ◽

Injury Severity ◽

Kidney Injury ◽

Diagnostic Tools ◽

Heme Oxygenase 1 ◽

Trauma Patients ◽

Independent Manner ◽

Equal Distribution ◽

Expression Levels ◽

Trauma Severity

AbstractIntensive care unit (ICU)-acquired delirium is associated with adverse outcome in trauma patients with concomitant traumatic brain injury (TBI), but diagnosis remains challenging. Quantifying circadian disruption by analyzing expression of the circadian gene period circadian regulator 2 (PER2) and heme oxygenase 1 (HO1), which determines heme turnover, may prove to be potential diagnostic tools. Expression of PER2 and HO1 was quantified using qPCR from blood samples 1 day and 7 days after trauma. Association analysis was performed comparing mRNA expression levels with parameters of trauma (ISS—injury severity score), delirium, acute kidney injury (AKI) and length of ICU stay. 48 polytraumatized patients were included (equal distribution of TBI versus non-TBI) corrected for ISS, age and gender using a matched pairs approach. Expression levels of PER2 and HO1 were independent of age (PER2: P = 0.935; HO1: P = 0.988), while expression levels were significantly correlated with trauma severity (PER2: P = 0.009; HO1: P < 0.001) and longer ICU length of stay (PER2: P = 0.018; HO1: P < 0.001). High expression levels increased the odds of delirium occurrence (PER2: OR = 4.32 [1.14–13.87]; HO1: OR = 4.50 [1.23–14.42]). Patients with TBI showed a trend towards elevated PER2 (OR = 3.00 [0.84–9.33], P = 0.125), but not towards delirium occurrence (P = 0.556). TBI patients were less likely to develop AKI compared to non-TBI (P = 0.022). Expression levels of PER2 and HO1 correlate with the incidence of delirium in an age-independent manner and may potentially improve diagnostic algorithms when used as delirium biomarkers.Trial registration: German Clinical Trials Register (Trial-ID DRKS00008981; Universal Trial Number U1111-1172-6077; Jan. 18, 2018).

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