David Lee Skinner1, Victor Y Kong2, Kim de Vasconcellos3, John L Bruce2, Wanda Bekker2, Grant L Laing2, Damian L Clarke2. 1. Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa. Electronic address: drdavidskinner@gmail.com. 2. Department of Surgery, Pietermartizburg, School of Clinical Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa. 3. Department of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
Abstract
BACKGROUND: This study sought to describe the burden of disease of acute kidney injury (AKI) among adult South African trauma patients who presented to a tertiary level trauma service. METHODS: The trauma database was interrogated for the period from December 2012 to July 2017. All patients over the age of 18 y, who were admitted following trauma, were included. Outcome data were reviewed. This included in-hospital mortality, need for intensive care unit admission, and length of stay. AKI was defined according to the latest Kidney Disease Improving Global Outcomes guidelines using the presentation serum creatinine. RESULTS: A total of 7613 patients were admitted for trauma over the period under review. Four thousand two hundred sixty-six patients were suitable for analysis. A total of 238 (5.6%) patients presented with AKI, 149 (62.6%) had stage 1 AKI, 40 (16.8%) had stage 2 AKI, and 49 (20.6%) had stage 3 AKI. There was a higher incidence of AKI in patients with blunt trauma. The length of stay, need for intensive care unit admission, and mortality were significantly higher in patients presenting with AKI than in those who did not present with AKI. There were 172 deaths (4.0%). The patients who died were older and had significantly higher Injury Severity Score than survivors. They were more acidotic on presentation, had lower Glasgow Coma Scale, and were more likely to be hypotensive on presentation. They also were significantly more likely to have AKI on presentation. (30.2% versus 5.6% P < 0.001). AKI on presentation was an independent risk factor for mortality (odds ratio 3.038 95% confidence interval 1.260-7.325). CONCLUSIONS: AKI is common in patients presenting to our center with acute trauma. The presence of AKI is associated with increased morbidity and mortality. Efforts must be directed to improving recognition of at-risk patients. Prompt referral and adequate resuscitation of trauma patients before transfer must be prioritized.
BACKGROUND: This study sought to describe the burden of disease of acute kidney injury (AKI) among adult South African traumapatients who presented to a tertiary level trauma service. METHODS: The trauma database was interrogated for the period from December 2012 to July 2017. All patients over the age of 18 y, who were admitted following trauma, were included. Outcome data were reviewed. This included in-hospital mortality, need for intensive care unit admission, and length of stay. AKI was defined according to the latest Kidney Disease Improving Global Outcomes guidelines using the presentation serum creatinine. RESULTS: A total of 7613 patients were admitted for trauma over the period under review. Four thousand two hundred sixty-six patients were suitable for analysis. A total of 238 (5.6%) patients presented with AKI, 149 (62.6%) had stage 1 AKI, 40 (16.8%) had stage 2 AKI, and 49 (20.6%) had stage 3 AKI. There was a higher incidence of AKI in patients with blunt trauma. The length of stay, need for intensive care unit admission, and mortality were significantly higher in patients presenting with AKI than in those who did not present with AKI. There were 172 deaths (4.0%). The patients who died were older and had significantly higher Injury Severity Score than survivors. They were more acidotic on presentation, had lower Glasgow Coma Scale, and were more likely to be hypotensive on presentation. They also were significantly more likely to have AKI on presentation. (30.2% versus 5.6% P < 0.001). AKI on presentation was an independent risk factor for mortality (odds ratio 3.038 95% confidence interval 1.260-7.325). CONCLUSIONS: AKI is common in patients presenting to our center with acute trauma. The presence of AKI is associated with increased morbidity and mortality. Efforts must be directed to improving recognition of at-risk patients. Prompt referral and adequate resuscitation of traumapatients before transfer must be prioritized.
Authors: Erica C Bjornstad; William Muronya; Zachary H Smith; Keisha Gibson; Amy K Mottl; Anthony Charles; Stephen W Marshall; Yvonne M Golightly; Charles K Munthali; Emily W Gower Journal: BMC Nephrol Date: 2020-03-14 Impact factor: 2.388
Authors: Erica C Bjornstad; Zachary H Smith; William Muronya; Charles K Munthali; Amy K Mottl; Stephen W Marshall; Yvonne M Golightly; Keisha Gibson; Anthony Charles; Emily W Gower Journal: BMC Nephrol Date: 2021-10-28 Impact factor: 2.388
Authors: Ryan E Aylward; Elizabeth van der Merwe; Sisa Pazi; Minette van Niekerk; Jason Ensor; Debbie Baker; Robert J Freercks Journal: BMC Nephrol Date: 2019-12-10 Impact factor: 2.388