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The incidence and associations of acute kidney injury in trauma patients admitted to critical care

A systematic review and meta-analysis

Haines, Ryan W., MBBS; Fowler, Alex J., MBBS; Kirwan, Christopher J., MD; Prowle, John R., MD

Journal of Trauma and Acute Care Surgery: January 2019 - Volume 86 - Issue 1 - p 141–147
doi: 10.1097/TA.0000000000002085
SYSTEMATIC REVIEW

BACKGROUND As more patients are surviving the initial effects of traumatic injury clinicians are faced with managing the systemic complications of severe tissue injury. Of these, acute kidney injury (AKI) may be a sentinel complication contributing to adverse outcomes.

OBJECTIVE To establish the incidence of AKI in patients admitted to critical care after major trauma, to explore any risk factors and to evaluate the association of AKI with outcomes.

DATA SOURCES Systematic search of MEDLINE, Excerpta Medica database and Cochrane library from January 2004 to April 2018.

STUDY SELECTION Studies of adult major trauma patients admitted to critical care that applied consensus AKI criteria (risk injury failure loss end stage [RIFLE], AKI network, or kidney disease improving global outcomes) and reported clinical outcomes were assessed (PROSPERO Registration: CRD42017056781). Of the 35 full-text articles selected from the screening, 17 (48.6%) studies were included.

DATA EXTRACTION AND SYNTHESIS We followed the PRISMA guidelines and study quality was assessed using the Newcastle-Ottawa score. The pooled incidence of AKI and relative risk of death were estimated using random-effects models.

MAIN OUTCOMES AND MEASURES Incidence of AKI was the primary outcome. The secondary outcome was study-defined mortality.

RESULTS We included 17 articles describing AKI outcomes in 24,267 trauma patients. The pooled incidence of AKI was 20.4% (95% confidence interval [CI], 16.5–24.9). Twelve studies reported the breakdown of stages of AKI with 55.7% of patients classified as RIFLE-R or stage 1, 30.3% as RIFLE-I or stage 2, and 14.0% as RIFLE-F or stage 3. The pooled relative risk of death with AKI compared was 3.6 (95% CI, 2.4–5.3). In addition, there was a concordant increase in odds of death among six studies that adjusted for multiple variables (adjusted odds ratio, 2.7; 95% CI, 1.9–3.8; p = <0.01).

CONCLUSION Acute kidney injury is common after major trauma and associated with increased mortality. Future research is warranted to reduce the potential for harm associated with this subtype of AKI.

LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.

From the Adult Critical Care Unit (R.Y.H., A.J.F., C.J.K., J.R.P.), The Royal London Hospital, Barts Health NHS Trust; William Harvey Research Institute (R.W.H., A.J.F., C.J.K., J.R.P.), Queen Mary University of London; and Department of Renal Medicine and Transplantation (C.J.K., J.R.P.), The Royal London Hospital, Barts Health, NHS Trust, London, United Kingdom.

Submitted: August 6, 2018, Accepted: September 25, 2018, Published online: October 25, 2018.

Address for reprints: John R. Prowle, MD, Adult Critical Care Unit, Royal London Hospital, London E1 1BB, United Kingdom; email: j.prowle@qmul.ac.uk.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

© 2019 Lippincott Williams & Wilkins, Inc.