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.
Injury. 2022 Jan;53(1):81-85. doi: 10.1016/j.injury.2021.09.039. Epub 2021 Oct 1.
Acute kidney injury (AKI) after trauma is a major complication independently associated with a prolonged hospital stay and increased mortality. We previously reported that the prehospital systolic blood pressure (SBP) and early hospital arterial lactate level, along with specific cut-off values, show good performance in the early prediction of AKI using AUC-ROC [1]. The purpose of this study was to prospectively validate whether or not these parameters are predictive of newly occurring AKI after trauma.
This was a prospective review of trauma patients who were admitted to a single trauma center from January to December 2019. Patients who were <16 years old, who had burns, and who had chronic kidney disease were excluded. AKI was defined according to the Risk, Injury, Failure, Loss of the kidney function, and End-stage kidney disease (RIFLE) classification based on serum creatinine alone. Patients with a low prehospital SBP (≤126 mmHg) and high lactate levels (≥2.5 mmol/L) were defined as the high-risk group, and other patients were defined as the low-risk group.
A total of 489 trauma patients were admitted to our center, of whom 403 were eligible for the study. The high-risk group consisted of 38 patients, and the low-risk group consisted of 365 patients. The incidence of severe AKI in Stage Injury and Failure was significantly higher in the high-risk group (5 patients, 13.2%) than in the low-risk group (7 patients, 1.9%), with an odds ratio of 7.75 and 95% confidence interval of 2.33-25.77.
These predictors showed good performance in the early prediction of severe AKI after trauma. Early prediction of the high-risk groups for severe AKI after trauma prompting early treatment may help improve the prognosis of trauma patients.
创伤后急性肾损伤（AKI）是一种主要并发症，与住院时间延长和死亡率增加独立相关。我们之前报道过，在使用 AUC-ROC [1] 进行 AKI 的早期预测时，院前收缩压（SBP）和早期医院动脉血乳酸水平以及特定的临界值表现良好。本研究的目的是前瞻性验证这些参数是否可预测创伤后新发生的 AKI。
这是对 2019 年 1 月至 12 月期间入住单一创伤中心的创伤患者进行的前瞻性回顾性研究。排除年龄<16 岁、烧伤和慢性肾脏病的患者。AKI 根据单独基于血清肌酐的风险、损伤、衰竭、丧失肾脏功能和终末期肾脏疾病（RIFLE）分类进行定义。将院前 SBP（≤126mmHg）低和乳酸水平（≥2.5mmol/L）高的患者定义为高危组，其他患者定义为低危组。
共有 489 名创伤患者入住我院，其中 403 名符合研究条件。高危组有 38 名患者，低危组有 365 名患者。高危组在损伤和衰竭阶段严重 AKI 的发生率明显高于低危组（5 例，13.2%），与低危组（7 例，1.9%）相比，优势比为 7.75，95%置信区间为 2.33-25.77。
这些预测因素在创伤后严重 AKI 的早期预测中表现良好。对创伤后严重 AKI 高危人群的早期预测提示早期治疗，可能有助于改善创伤患者的预后。
