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Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis

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Abstract

Purpose

To perform a systematic review and meta-analysis of acute kidney injury (AKI) in trauma patients admitted to the intensive care unit (ICU).

Methods

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.

Results

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.

Conclusions

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.

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Funding

This study was funded by the authors’ institutions only.

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Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Akershus University Hospital, Lørenskog, Norway

    Signe Søvik

  2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

    Signe Søvik, Kine Marie Nordhuus, Christine Kooy Tveiten, Torsten Eken & Kjetil Sunde

  3. Medical Library at Ullevål Hospital, University of Oslo Library, Oslo, Norway

    Marie Susanna Isachsen

  4. Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway

    Torsten Eken, Kjetil Sunde & Sigrid Beitland

  5. Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway

    Kjetil Gundro Brurberg

  6. Center for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway

    Kjetil Gundro Brurberg

  7. Renal Research Group Ullevål, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

    Sigrid Beitland

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  1. Signe Søvik
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  2. Marie Susanna Isachsen
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Søvik, S., Isachsen, M.S., Nordhuus, K.M. et al. Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis. Intensive Care Med 45, 407–419 (2019). https://doi.org/10.1007/s00134-019-05535-y

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