Lee Kangho, Ryu Dongyeon, Kim Hohyun, Park Sungjin, Lee Sangbong, Park Chanik, Kim Gilhwan, Kim Sunhyun, Lee Nahyeon
Department of Trauma and Surgical Critical Care, Pusan National University Hospital, Busan, Korea.
Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Acute Crit Care. 2023 Feb;38(1):95-103. doi: 10.4266/acc.2022.01046. Epub 2023 Feb 27.
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE).
We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs.
The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage.
In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.
在严重创伤患者中，急性肾损伤（AKI）的诊断很重要，因为它是预后不良的预测因素，并且会影响患者的治疗。AKI的诊断和分期基于血清肌酐（SCr）水平相对于基线的变化。然而，创伤患者的基线肌酐水平通常未知，这使得创伤患者的AKI诊断变得困难。本研究旨在通过提供适当的参考肌酐估计值（RCE）来提高创伤患者AKI诊断的准确性。
我们回顾了2015年至2019年期间在韩国一家地区创伤中心需要入住重症监护病房的成年严重创伤患者（n = 3228）。根据肾脏病改善全球预后组织发布的现行指南诊断AKI。使用以下RCE确定AKI：估计的SCr75-肾脏病饮食改良（MDRD）、创伤MDRD（TMDRD）、入院肌酐水平和第一天肌酐最低点。我们使用不同的RCE评估包容性、预后能力和增量性。
根据所使用的RCE，AKI的发生率在15%至46%之间变化。用于预测死亡率和肾脏替代治疗（RRT）需求的TMDRD的受试者工作特征曲线具有最高值且具有统计学意义（分别为0.797，P<0.001；0.890，P = 0.002）。此外，使用TMDRD导致死亡率预后能力，并且RRT的需求随AKI分期增加。
在本研究中，TMDRD作为RCE是可行的，可实现创伤后AKI的最佳诊断和预后。
