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Intensive Care Medicine

, Volume 45, Issue 4, pp 407–419 | Cite as

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

  • Signe SøvikEmail author
  • Marie Susanna Isachsen
  • Kine Marie Nordhuus
  • Christine Kooy Tveiten
  • Torsten Eken
  • Kjetil Sunde
  • Kjetil Gundro Brurberg
  • Sigrid Beitland
Systematic Review

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.

Keywords

Acute kidney injury Wounds and injuries Critical illness Risk factors Mortality Systematic review 

Notes

Funding

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.

Ethical approval

An approval by an ethics committee was not applicable.

Supplementary material

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Supplementary material 1 (PDF 68 kb)
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Supplementary material 2 (PDF 58 kb)
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Supplementary material 3 (PDF 73 kb)
134_2019_5535_MOESM4_ESM.pdf (74 kb)
Supplementary material 4 (PDF 74 kb)
134_2019_5535_MOESM5_ESM.pdf (1.2 mb)
Supplementary material 5 (PDF 1258 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Anaesthesia and Intensive CareAkershus University HospitalLørenskogNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Medical Library at Ullevål HospitalUniversity of Oslo LibraryOsloNorway
  4. 4.Department of Anaesthesiology, Division of Emergencies and Critical CareOslo University Hospital UllevålOsloNorway
  5. 5.Division for Health ServicesNorwegian Institute of Public HealthOsloNorway
  6. 6.Center for Evidence Based PracticeWestern Norway University of Applied SciencesBergenNorway
  7. 7.Renal Research Group Ullevål, Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway

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