Document Detail

Acute kidney injury and posttrauma multiple organ failure: the canary in the coal mine.
MedLine Citation:
PMID:  22327979     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Despite improved resuscitation strategies, acute kidney injury (AKI) remains an important cause of morbidity and high resource use among severely injured patients. Thus, we conducted a comprehensive evaluation of the epidemiology and outcomes of early AKI among severely injured patients as well as its impact on the development of postinjury multiple organ failure (MOF).
METHODS: We queried our 17-year database of high-risk postinjury patients (Injury Severity Score >15, age >15 years, survival >48 hours, and no isolated head injury). MOF and AKI (creatinine >1.8 mg/dL) were defined by the Denver MOF score. Patients with documented preexisting renal, hepatic, cardiac, or pulmonary disease (120, 5%) were excluded, leaving 2157 for analysis.
RESULTS: Early (day 2) AKI was evident in 2.13% of the patients and associated with a 78% MOF incidence and 27% mortality. Both rates were higher than those associated with early heart, lung, or liver failure.
CONCLUSION: Early AKI is a harbinger of adverse outcome postinjury, outperforming hepatic, cardiac, or pulmonary dysfunction as a predictor of MOF and death. Prevention of early AKI and a better understanding of organ crosstalk may help reduce AKI-associated morbidity, mortality, and obligatory costs of this complication.
LEVEL OF EVIDENCE: I, prognostic study.
Max V Wohlauer; Angela Sauaia; Ernest E Moore; Clay Cothren Burlew; Anirban Banerjee; Jeffrey Johnson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-13     Completed Date:  2012-05-04     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  373-8; discussion 379-80     Citation Subset:  AIM; IM    
Department of Surgery, University of Colorado-Denver, CO 80204, USA.
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MeSH Terms
Acute Disease
Chi-Square Distribution
Colorado / epidemiology
Injury Severity Score
Kidney / injuries*
Kidney Function Tests
Logistic Models
Middle Aged
Multiple Organ Failure / epidemiology,  etiology,  physiopathology*,  therapy*
Prospective Studies
Renal Replacement Therapy
Risk Factors
Statistics, Nonparametric
Survival Rate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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