Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan.
Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan.
J Surg Res. 2021 Sep;265:180-186. doi: 10.1016/j.jss.2021.03.037. Epub 2021 Apr 30.
The purpose of this study is to report the prevalence of acute kidney injury (AKI) after trauma in our center, describe the risk factors associated with AKI, and determine whether these risk factors help avoid AKI.
We retrospectively analyzed the data which were prospectively collected from a single center trauma registry from January 2017 to December 2018. Patients who were <16 years of age, patients with burns, and patients with chronic kidney disease were excluded from the present study. AKI was defined according to the risk, injury, failure, loss of the kidney function, and end-stage kidney disease (RIFLE) classification from serum creatinine alone. A logistic regression analysis was performed to identify prehospital and early hospital risk factors for AKI.
There were 806 trauma patients recorded in the database. One hundred thirty cases were excluded based on the abovementioned exclusion criteria. Six hundred seventy-six patients were included in the analysis. The prevalence of AKI in the overall population was 14.5% including 10.5% of patients with stage R, 3.0% of patients with stage I and 1.0% with stage F. The incidence of AKI increased to 36.3%, 12.1% and 3.3% in the subgroup of patients with hemorrhagic shock. The multivariate analysis revealed that the minimum prehospital systolic blood pressure and arterial lactate level were independent predictors of AKI. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC-ROC) of 0.867 and 0.852 in the prediction of AKI stage I or F. The cutoff values were ≤126 mmHg and ≥2.5 mmol/L, respectively.
These parameters showed good performance in the early prediction of AKI after trauma. They are associated with the early onset of AKI after trauma and may be an early predictor of the effects of treatment to prevent AKI.
本研究旨在报告我院创伤后急性肾损伤（AKI）的发生率，描述与 AKI 相关的危险因素，并确定这些危险因素是否有助于避免 AKI。
我们回顾性分析了 2017 年 1 月至 2018 年 12 月期间从单中心创伤登记处前瞻性收集的数据。本研究排除了<16 岁、烧伤和慢性肾脏病患者。AKI 定义为血清肌酐单独依据风险、损伤、衰竭、丧失和终末期肾病（RIFLE）分类。采用 logistic 回归分析确定创伤前和早期医院 AKI 的危险因素。
数据库中记录了 806 例创伤患者。根据上述排除标准，排除了 130 例。676 例患者纳入分析。总体人群 AKI 发生率为 14.5%，其中 R 期 10.5%，I 期 3.0%，F 期 1.0%。在失血性休克患者亚组中，AKI 的发生率分别增至 36.3%、12.1%和 3.3%。多变量分析显示，创伤前最低收缩压和动脉血乳酸水平是 AKI 的独立预测因素。该模型在预测 I 期或 F 期 AKI 时具有良好的判别能力，受试者工作特征曲线（ROC）下面积（AUC-ROC）分别为 0.867 和 0.852。截断值分别为≤126mmHg 和≥2.5mmol/L。
这些参数在创伤后 AKI 的早期预测中表现良好。它们与创伤后 AKI 的早期发生有关，可能是治疗效果的早期预测指标，有助于预防 AKI。
