Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis
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.
KeywordsAcute kidney injury Wounds and injuries Critical illness Risk factors Mortality Systematic review
This study was funded by the authors’ institutions only.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest regarding this study.
An approval by an ethics committee was not applicable.
- 3.Bellomo R, Ronco C, Kellum JA et al (2004) Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212Google Scholar
- 4.Mehta RL, Kellum JA, Shah SV et al (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 11:R31Google Scholar
- 6.Joannidis M, Druml W, Forni LG et al (2017) Prevention of acute kidney injury and protection of renal function in the intensive care unit: update 2017: expert opinion of the Working Group on Prevention, AKI section, European Society of Intensive Care Medicine. Intensive Care Med 43:730–749. https://doi.org/10.1007/s00134-017-4832-y Google Scholar
- 12.Søvik S, Isachsen MS, Nordhuus KM, et al (2018) Acute kidney injury in trauma patients admitted to the intensive care unit: a systematic review and meta-analysis. In: 31st annual congress of the European Society of Intensive Care Medicine, Paris, 20–24 October 2018Google Scholar
- 13.Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196Google Scholar
- 14.Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963Google Scholar
- 15.Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829Google Scholar
- 17.Wells GA, Shea B, OConnell D, et al (2000) The Newcastle–Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 01 Jan 2019
- 19.Schwarzer G (2015) Meta: general package for meta-analysis, R Package Version 4.3–2. https://CRAN.R-project.org/package=meta
- 20.Gordon M, Lumley T (2017) forestplot: Advanced forest plot using “grid” graphics. R package version 1.7. https://CRAN.R-project.org/package=forestplot
- 21.Higgins JPT, Deeks JJ (eds) (2011) Chapter 7: Selecting studies and collecting data. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org
- 22.Schünemann HJ, Oxman AD, Vist GE et al (2011) Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.handbook.cochrane.org
- 23.Cochran WG (2018) The combination of estimates from different experiments. Biometrics 10:101–129Google Scholar
- 29.Kamar C, Ali A, Altun D et al (2017) Evaluation of risk factors and development of acute kidney injury in aneurysmal subarachnoid hemorrhage, head injury, and severe sepsis/septic shock patients during ICU treatment. Ulus Travma Acil Cerrahi Derg 23:39–45. https://doi.org/10.5505/tjtes.2016.83451 Google Scholar
- 37.Zand F, Sabetian G, Abbasi G et al (2015) Early acute kidney injury based on serum creatinine or cystatin C in intensive care unit after major trauma. Iran J Med Sci 40:485–492Google Scholar
- 39.Ahmed M, Sriganesh K, Vinay B, Umamaheswara Rao GS (2015) Acute kidney injury in survivors of surgery for severe traumatic brain injury: incidence, risk factors, and outcome from a tertiary neuroscience center in India. Br J Neurosurg 29:544–548. https://doi.org/10.3109/02688697.2015.1016892 Google Scholar
- 57.Yuan F, Hou FF, Wu Q et al (2009) Natural history and impact on outcomes of acute kidney injury in patients with road traffic injury. Clin Nephrol 71:669–679Google Scholar
- 61.Lee SA, Cozzi M, Bush EL, Rabb H (2018) Distant organ dysfunction in acute kidney injury: a review. Am J Kidney Dis 72:846–856. https://doi.org/10.1053/j.ajkd.2018.03.028