Hatton Gabrielle E, Harvin John A, Wade Charles E, Kao Lillian S
Surgery, University of Texas McGovern Medical School, Houston, Texas, USA.
Trauma Surg Acute Care Open. 2021 May 27;6(1):e000689. doi: 10.1136/tsaco-2021-000689. eCollection 2021.
Acute kidney injury (AKI) is common after severe trauma. AKI incidence and AKI stage have previously been shown to be associated with poor outcomes after trauma. However, AKI duration may also be important for outcomes after trauma, given that it is associated with long-term morbidity and mortality in general intensive care unit (ICU) and hospitalized patients. We hypothesized that duration of AKI is independently associated with poor outcomes after trauma.
A cohort study was conducted at a single, level 1 trauma center. Patients admitted to the ICU between 2009 and 2018 were included. Data were extracted from the trauma registry and electronic medical records. AKI within 7 days from presentation was defined according to the Kidney Disease Improving Global Outcomes guidelines. Multivariable analyses were performed to assess the association between AKI incidence, AKI stage, and AKI duration with outcomes including prolonged ICU and hospital length of stay, discharge to home, and mortality.
Of 7049 patients included, 72% were male, the median age was 41 years (IQR 27-58), and 10% died. The AKI incidence was 45%, with 69% of these patients presenting with AKI on arrival. The majority (73%) of patients who suffered AKI recovered within 2 days. After adjustment in separate models, AKI incidence, AKI stage and AKI duration were each associated with prolonged hospitalization, an unfavorable discharge disposition, and mortality. AKI stage and duration were not used in the same model due to collinearity.
Post-traumatic AKI was common on arrival and frequently short lasting. Duration correlated with highest AKI stage, and both were separately associated with prolonged hospitalization, discharge destination other than home, and mortality on adjusted analyses. Given the high incidence of AKI on arrival, stage or duration may be better targets for future interventions and quality improvement initiatives to improve outcomes after post-traumatic AKI.
III. Prognostic.
急性肾损伤（AKI）在严重创伤后很常见。此前已有研究表明，AKI的发生率和分期与创伤后的不良预后相关。然而，考虑到AKI持续时间与普通重症监护病房（ICU）和住院患者的长期发病率和死亡率相关，其可能对创伤后的预后也很重要。我们假设AKI持续时间与创伤后的不良预后独立相关。
在一家一级创伤中心进行了一项队列研究。纳入2009年至2018年间入住ICU的患者。数据从创伤登记处和电子病历中提取。根据改善全球肾脏病预后组织（KDIGO）指南定义入院7天内的AKI。进行多变量分析以评估AKI发生率、分期和持续时间与包括ICU和住院时间延长、出院回家以及死亡率等预后之间的关联。
纳入的7049例患者中，72%为男性，中位年龄为41岁（四分位间距27 - 58岁），10%死亡。AKI发生率为45%，其中69%的患者入院时即出现AKI。大多数（73%）发生AKI的患者在2天内恢复。在单独模型中进行调整后，AKI发生率、分期和持续时间均与住院时间延长、不良出院结局和死亡率相关。由于共线性，AKI分期和持续时间未在同一模型中使用。
创伤后AKI在入院时很常见且通常持续时间短。持续时间与最高AKI分期相关，在调整分析中，两者均分别与住院时间延长、非回家的出院目的地以及死亡率相关。鉴于入院时AKI的高发生率，分期或持续时间可能是未来干预和质量改进措施的更好目标，以改善创伤后AKI的预后。
III. 预后性。
