Department of Anaesthesia and Intensive Care, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Intensive Care Med. 2019 Apr;45(4):407-419. doi: 10.1007/s00134-019-05535-y. Epub 2019 Feb 6.
To perform a systematic review and meta-analysis of acute kidney injury (AKI) in trauma patients admitted to the intensive care unit (ICU).
We conducted a systematic literature search of studies on AKI according to RIFLE, AKIN, or KDIGO criteria in trauma patients admitted to the ICU (PROSPERO CRD42017060420). We searched PubMed, Cochrane Database of Systematic Reviews, UpToDate, and NICE through 3 December 2018. Data were collected on incidence of AKI, risk factors, renal replacement therapy (RRT), renal recovery, length of stay (LOS), and mortality. Pooled analyses with random effects models yielded mean differences, OR, and RR, with 95% CI.
Twenty-four observational studies comprising 25,182 patients were included. Study quality (Newcastle-Ottawa scale) was moderate. Study heterogeneity was substantial. Incidence of post-traumatic AKI in the ICU was 24% (20-29), of which 13% (10-16) mild, 5% (3-7) moderate, and 4% (3-6) severe AKI. Risk factors for AKI were African American descent, high age, chronic hypertension, diabetes mellitus, high Injury Severity Score, abdominal injury, shock, low Glasgow Coma Scale (GCS) score, high APACHE II score, and sepsis. AKI patients had 6.0 (4.0-7.9) days longer ICU LOS and increased risk of death [RR 3.4 (2.1-5.7)] compared to non-AKI patients. In patients with AKI, RRT was used in 10% (6-15). Renal recovery occurred in 96% (78-100) of patients.
AKI occurred in 24% of trauma patients admitted to the ICU, with an RRT use among these of 10%. Presence of AKI was associated with increased LOS and mortality, but renal recovery in AKI survivors was good.
对 ICU 收治的创伤患者急性肾损伤（AKI）进行系统回顾和荟萃分析。
我们根据 RIFLE、AKIN 或 KDIGO 标准对 ICU 收治的创伤患者 AKI 进行了系统文献检索（PROSPERO CRD42017060420）。我们通过 3 日 12 月 2018 年搜索了 PubMed、Cochrane 系统评价数据库、UpToDate 和 NICE。收集 AKI 的发生率、危险因素、肾脏替代治疗（RRT）、肾脏恢复、住院时间（LOS）和死亡率的数据。使用随机效应模型进行汇总分析，得出均值差异、OR 和 RR，置信区间为 95%。
纳入了 24 项包含 25182 名患者的观察性研究。研究质量（纽卡斯尔-渥太华量表）为中等。研究异质性较大。ICU 收治的创伤后 AKI 发生率为 24%（20-29），其中 13%（10-16）为轻度 AKI、5%（3-7）为中度 AKI 和 4%（3-6）为重度 AKI。AKI 的危险因素包括非裔美国人、高龄、慢性高血压、糖尿病、高损伤严重度评分、腹部损伤、休克、低格拉斯哥昏迷量表（GCS）评分、高急性生理与慢性健康状况评分 II（APACHE II）评分和脓毒症。与非 AKI 患者相比，AKI 患者 ICU LOS 延长 6.0 天（4.0-7.9），死亡风险增加[RR 3.4（2.1-5.7）]。在 AKI 患者中，有 10%（6-15）使用了 RRT。AKI 幸存者中 96%（78-100）出现了肾脏恢复。
ICU 收治的创伤患者中有 24%发生 AKI，其中 10%使用 RRT。AKI 的存在与 LOS 和死亡率增加相关，但 AKI 幸存者的肾脏恢复良好。
