Incidence and Outcome of Early Acute Kidney Injury in Critically-Ill Trauma Patients

OBJECTIVE To determine the incidence and effect on mortality of early acute kidney injury in severely injured trauma patients using the Acute Kidney Injury Network creatinine criteria. DESIGN A retrospective cohort study of severely injured trauma patients admitted to the shock trauma intensive care unit. SETTING Texas Trauma Institute, a state designated level I trauma unit certified by the American College of Surgeons Committee on Trauma. PATIENTS 901 severely injured trauma patients admitted over a 15 month period to the shock trauma intensive care unit. INTERVENTIONS Retrospective analysis of prospectively collected data abstracted from an electronic trauma database. MEASUREMENTS AND MAIN RESULTS Of 901 eligible patients admitted to the shock trauma intensive care unit after traumatic injury, 54 patients (6%) developed acute kidney injury, of whom 10 (19%) required renal replacement therapy. The 30-day mortality rate for the entire cohort was 83/901 (9.2%). Patients with early acute kidney injury had a mortality rate of 16/54 (29.6%). When corrected for multiple covariates including injury severity scores, the development of early acute kidney injury was associated with a significantly higher risk of death at 30 days with an OR of 3.4 (95% CI 1.6-7.4). CONCLUSIONS Applying the Acute Kidney Injury Network creatinine criteria in severely injured trauma patients, the incidence of early acute kidney injury was 6%. After correction for injury severity, development of early acute kidney injury was independently associated with significantly higher 30-day mortality.