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Li PH, Fu CY, Bokhari F. Associations between hollow viscus injury and acute kidney injury in blunt abdominal trauma: A national trauma data bank analysis. World J Surg 2024. [PMID: 38964867 DOI: 10.1002/wjs.12280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE It is well established that hollow viscus perforation leads to sepsis and acute kidney injury (AKI) in non-trauma patients. However, the relationship between traumatic hollow viscus injury (HVI) and AKI is not well understood. Utilizing data from the National Trauma Data Bank, we investigated whether HVI serves as a risk factor for AKI. Additionally, we examined the characteristics of AKI in stable patients who underwent conservative treatment. METHODS We reviewed blunt abdominal trauma (BAT) cases from 2012 to 2015, comparing patients with and without AKI. Significant factors from univariate analysis were tested in a multivariate logistic regression (MLR) to identify independent AKI determinants. We also analyzed subsets: patients without HVI and stable patients given conservative management. RESULTS Out of the 563,040 BAT patients analyzed, 9073 (1.6%) developed AKI. While a greater proportion of AKI patients had HVI than those without AKI (13.3% vs. 5.2%, p < 0.001), this difference wasn't statistically significant in the MLR (p = 0.125). Notably, the need for laparotomy (odds = 3.108, p < 0.001) and sepsis (odds = 13.220, p < 0.001) were identified as independent risk factors for AKI. For BAT patients managed conservatively (systolic blood pressure >90 mmHg, without HVI or laparotomy; N = 497,066), the presence of sepsis was a significant predictor for the development of AKI (odds = 16.914, p < 0.001). CONCLUSIONS While HVI wasn't a significant risk factor for AKI in BAT patients, the need for laparotomy was. Stable BAT patients managed conservatively are still at risk for AKI due to non-peritonitis related sepsis.
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Affiliation(s)
- Pei-Hua Li
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, Illinois, USA
| | - Faran Bokhari
- Department of Trauma and Burn Surgery, Stroger Hospital of Cook County, Rush University, Chicago, Illinois, USA
- Emergency Surgical Services, St. Francis Hospital, OSF Healthcare System, Peoria, Illinois, USA
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Xing Z, Xu Y, Wu Y, Fu X, Shen P, Che W, Wang J. Development and validation of a nomogram for predicting in-hospital mortality in patients with nonhip femoral fractures. Eur J Med Res 2023; 28:539. [PMID: 38001553 PMCID: PMC10668411 DOI: 10.1186/s40001-023-01515-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The incidence of nonhip femoral fractures is gradually increasing, but few studies have explored the risk factors for in-hospital death in patients with nonhip femoral fractures in the ICU or developed mortality prediction models. Therefore, we chose to study this specific patient group, hoping to help clinicians improve the prognosis of patients. METHODS This is a retrospective study based on the data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Least absolute shrinkage and selection operator (LASSO) regression was used to screen risk factors. The receiver operating characteristic (ROC) curve was drawn, and the areas under the curve (AUC), net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the discrimination of the model. The consistency between the actual probability and the predicted probability was assessed by the calibration curve and Hosmer-Lemeshow goodness of fit test (HL test). Decision curve analysis (DCA) was performed, and the nomogram was compared with the scoring system commonly used in clinical practice to evaluate the clinical net benefit. RESULTS The LASSO regression analysis showed that heart rate, temperature, red blood cell distribution width, blood urea nitrogen, Glasgow Coma Scale (GCS), Simplified Acute Physiology Score II (SAPSII), Charlson comorbidity index and cerebrovascular disease were independent risk factors for in-hospital death in patients with nonhip femoral fractures. The AUC, IDI and NRI of our model in the training set and validation set were better than those of the GCS and SAPSII scoring systems. The calibration curve and HL test results showed that our model prediction results were in good agreement with the actual results (P = 0.833 for the HL test of the training set and P = 0.767 for the HL test of the validation set). DCA showed that our model had a better clinical net benefit than the GCS and SAPSII scoring systems. CONCLUSION In this study, the independent risk factors for in-hospital death in patients with nonhip femoral fractures were determined, and a prediction model was constructed. The results of this study may help to improve the clinical prognosis of patients with nonhip femoral fractures.
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Affiliation(s)
- Zhibin Xing
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yiwen Xu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yuxuan Wu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaochen Fu
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Pengfei Shen
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenqiang Che
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jing Wang
- The First Affiliated Hospital of Jinan University, Guangzhou, China.
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Mariano F, Mella A, Randone P, Agostini F, Bergamo D, Berardino M, Biancone L. Safety and Metabolic Tolerance of Citrate Anticoagulation in Critically Ill Polytrauma Patients with Acute Kidney Injury Requiring an Early Continuous Kidney Replacement Therapy. Biomedicines 2023; 11:2570. [PMID: 37761011 PMCID: PMC10526994 DOI: 10.3390/biomedicines11092570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/15/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
For severe polytrauma patients with an early AKI requiring renal replacement therapy, anticoagulation remains a great challenge. Due to a high bleeding risk, hemodynamic instability, and increased lactate levels, continuous modality (CKRT) and citrate anticoagulation seem to be the most appropriate. However, their safety with regard to the potential risk of impaired citrate metabolism is not documented. A retrospective study of 60 severe polytrauma patients admitted to the emergency department between January 2000 and December 2021 was conducted; the patients requiring CKRT during the first 72 h were treated with citrate (n. 46, group Citrate) or with heparin (n. 14, group Heparin). Out of 60 patients, 31 survived (51.7%). According to logistic regression analysis, age and SOFA score were significant predictors of mortality. The incidence of rhabdomyolysis was more common in the survivors (77.4 vs. 51.7%), and Kaplan-Meyer analysis showed a better trend towards survival at 90 days for the group Citrate than the group Heparin (p 0.0956). In the group Citrate, hemorrhagic episodes were significantly less common (0.045 vs. 0.273 episodes/day, p < 0.001); the effective duration (h/day) of CKRT was longer; and the effective net ultrafiltration rate (mL/kg/h) and blood flow rate were lower. For severe polytrauma patients, early, soft CKRT with citrate anticoagulation at a low blood flow rate and circuit citratemia showed a better safety and hemodynamic stability, suggesting that citrate should be the first choice anticoagulant in this subset of patients.
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Affiliation(s)
- Filippo Mariano
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (A.M.); (D.B.); (L.B.)
- Nephrology, Dialysis and Transplantation U, University Hospital City of Science and Health, CTO Hospital, 10126 Turin, Italy;
| | - Alberto Mella
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (A.M.); (D.B.); (L.B.)
- Nephrology, Dialysis and Transplantation U, University Hospital City of Science and Health, CTO Hospital, 10126 Turin, Italy;
| | - Paolo Randone
- Nephrology, Dialysis and Transplantation U, University Hospital City of Science and Health, CTO Hospital, 10126 Turin, Italy;
| | - Fulvio Agostini
- Anesthesia and Intensive Care 3, University Hospital City of Science and Health, CTO Hospital, 10126 Turin, Italy; (F.A.); (M.B.)
| | - Daniela Bergamo
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (A.M.); (D.B.); (L.B.)
| | - Maurizio Berardino
- Anesthesia and Intensive Care 3, University Hospital City of Science and Health, CTO Hospital, 10126 Turin, Italy; (F.A.); (M.B.)
| | - Luigi Biancone
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy; (A.M.); (D.B.); (L.B.)
- Nephrology, Dialysis and Transplantation U, University Hospital City of Science and Health, CTO Hospital, 10126 Turin, Italy;
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Predisposing Factors and Outcome of Acute Kidney Injury After Blunt Trauma: A 10-Year Study. J Surg Res 2023; 284:193-203. [PMID: 36586312 DOI: 10.1016/j.jss.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) indicates an impairment of the renal function following blunt trauma. It is multifactorial and associated with an increased risk of morbidity and mortality. The incidence and risk factors of AKI in young patients with trauma are not well-described. This study aimed to evaluate the incidence, clinical characteristics, and outcomes of post-traumatic AKI. We hypothesized that AKI is associated with worse outcomes in patients with trauma. METHODS This was a retrospective study of all adult trauma patients admitted to a level 1 trauma center between 2011 and 2021. AKI was diagnosed on the basis of the Kidney Disease Improving Global Outcomes criteria. Data were collected and analyzed for patients with and without AKI using chi-square test and Student's t-test. Multivariate logistic regression analysis and Kaplan-Meier curves were performed. RESULTS A total of 17,341 patients with trauma were evaluated, of which 140 (0.8%) developed AKI. Patients with AKI were older (40 ± 20 versus 32 ± 16 y), had more comorbidities, and had a higher injury severity score (ISS) and in-hospital mortality (65% versus 3.2%) than non-AKI patients. Direct trauma to the kidney was reported in only nine (6.4%) patients in the AKI group. Among patients with AKI, nonsurvivors had a higher ISS and were more likely to have hypotension, elevated serum lactate, positive troponin, and a lower platelet-to-lymphocyte ratio than survivors. Multiple logistic regression analyses showed that age, ISS, acute respiratory distress syndrome, blood transfusion, diabetes mellitus, onadmission Glasgow coma scale score, and shock index were predictors of AKI in trauma patients, whereas ISS (odds ratio (OR) = 1.05; 95% confidence interval (CI):1.003-1.100; P = 0.03), serum lactate level (OR = 1.25; 95% CI: 1.019-1.533; P = 0.03), and hypotension (OR = 3.22; 95% CI: 1.044-9.945; P = 0.04) were independent predictors of mortality in patients with posttraumatic AKI. Kaplan-Meier survival analysis showed significant differences in mortality among the three stages of AKI (P = 0.03), with the worst outcome in stage III. However, after adjusting for age, hypotension, and ISS, the Cox regression model showed that only stage I had better survival than stages II and III, whereas no survival difference was noted between stages II and III (P = 0.06). CONCLUSIONS AKI in young trauma patients is uncommon and associated with a prolonged hospital course and higher mortality. This study identified factors that independently predicted the development of AKI and its outcomes in patients with trauma. However, further prospective and multicenter studies are required to minimize the incidence and complications of posttraumatic AKI.
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Acute Kidney Injury: Iterative Development of an Audit Tool for Trauma Patients. J Trauma Nurs 2023; 30:108-114. [PMID: 36881703 DOI: 10.1097/jtn.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Acute kidney injury is a low-volume, high-risk complication in trauma patients and is associated with prolonged hospital length of stay and increased mortality. Yet, no audit tools exist to evaluate acute kidney injury in trauma patients. OBJECTIVE This study aimed to describe the iterative development of an audit tool to evaluate acute kidney injury following trauma. METHODS Our performance improvement nurses developed an audit tool to evaluate acute kidney injury in trauma patients using an iterative, multiphase process conducted from 2017 to 2021, which included a review of our Trauma Quality Improvement Program data, trauma registry data, literature review, multidisciplinary consensus approach, retrospective and concurrent review, and continuous audit and feedback for piloted and finalized versions of the tool. RESULTS The final acute kidney injury audit tool can be completed within 30 min using data obtained from the electronic medical record and consists of six sections, including identification criteria, source potential causes, source treatment, acute kidney injury treatment, dialysis indications, and outcome status. CONCLUSION The iterative development and testing of an acute kidney injury audit tool improved the uniform data collection, documentation, audit, and feedback of best practices to positively impact patient outcomes.
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Soni KD, Singh A, Tyagi A, Singh Y, Aggarwal R, Trikha A. Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study. Indian J Crit Care Med 2023; 27:22-25. [PMID: 36756485 PMCID: PMC9886052 DOI: 10.5005/jp-journals-10071-24380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/18/2022] [Indexed: 01/02/2023] Open
Abstract
Background Acute kidney injury (AKI) following severe trauma is common. However, the requirement of renal replacement therapy (RRT) in these patients is rare and is associated with high morbidity and mortality. The primary objective of this study was to identify odds of risk factors, in particular, hypotension at presentation, for the requirement of RRT in patients with AKI following trauma. Methods We performed a case-control study involving patients who were admitted to the intensive care unit (ICU) at a level I trauma center for at least 24 hours. The primary outcome measure was a study of the odds of risk factors associated with the requirement of RRT in such patients. Univariate comparisons and multiple logistic regression analyses were done to identify other risk factors. Results The presence of crush injury, sepsis, and elevated serum creatinine (sCr) on arrival were identified to be independent risk factors for RRT requirement. Hypotension and exposure to radiocontrast or nephrotoxic antimicrobials were not found to be associated with the need for RRT. Acute kidney injury requiring RRT was associated with significantly increased ICU length of stay (15 days vs 5 days; p < 0.001) and higher mortality (83% vs 35%; p < 0.001). Conclusion The presence of crush injury, sepsis, and elevated sCr on presentation were identified to be independent risk factors while hypotension association was insignificant for AKI requiring RRT in our investigation. How to cite this article Soni KD, Singh A, Tyagi A, Singh Y, Aggarwal R, Trikha A. Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study. Indian J Crit Care Med 2023;27(1):22-25.
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Affiliation(s)
- Kapil Dev Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Singh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Abhay Tyagi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Yudhyavir Singh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India,Richa Aggarwal, Department Intensive Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India, Phone: +91 9873731042, e-mail:
| | - Anjan Trikha
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, United States of America
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Kuok CI, Chan WKY. Motor Vehicle Collision and Acute Kidney Injury in Children. Pediatr Emerg Care 2022; 38:545-549. [PMID: 35916728 DOI: 10.1097/pec.0000000000002677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our study aimed to determine the prevalence of acute kidney injury (AKI) in pediatric patients who sustained trauma due to motor vehicle collision (MVC) and identify factors associated with its development. METHODS We retrospectively reviewed the clinical information and laboratory tests of pediatric patients who were admitted because of MVC from January 2014 to April 2021. The occurrence of AKI was our primary outcome, which was defined by the Kidney Disease Improving Global Outcomes criteria. A serum creatine kinase (CK) level of 1000 IU/L or greater was defined as rhabdomyolysis. RESULTS Sixty-four patients (median age, 9.6 years) were included in the study. Twenty three of the patients (35.9%) developed AKI: stage 1 AKI in 18 (78.3%) and stage 2 AKI in 5 (21.7%) patients. Acute kidney injury patients had higher injury severity scores (no AKI: 5.0; stage 1 AKI: 10.5; stage 2 AKI: 26.0). Rhabdomyolysis was present in 21.1% of the patients and was associated with the overall AKI risk (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.6-32.6) and stage 2 AKI (OR, 15.0; 95% CI, 1.4-163.2). Blood tests from AKI patients showed lower serum bicarbonate and base excess, higher leukocyte and CK levels on admission, and a higher peak CK in the first 72 hours of admission. Intubation in emergency department (OR, 11.1; 95% CI, 1.2-102.1) and surgical interventions (OR, 3.2; 95% CI, 1.0-9.8) were associated with AKI. Acute kidney injury patients required longer stay in pediatric intensive care unit (median 1.0 vs 2.3 days, P < 0.001) and hospital (median 4.1 vs 7.0 days, P = 0.010). CONCLUSIONS Approximately one third of pediatric patients who sustained trauma from MVC developed AKI. Initial blood results, including higher CK and leukocyte count, and lower bicarbonate and base excess, were associated with the development of AKI. Rhabdomyolysis occurred in approximately one fifth of the patients and was significantly associated with AKI.
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Yamada H, Yanagita M. Global Perspectives in Acute Kidney Injury: Japan. KIDNEY360 2022; 3:1099-1104. [PMID: 35845320 PMCID: PMC9255879 DOI: 10.34067/kid.0007892021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/25/2022] [Indexed: 01/10/2023]
Affiliation(s)
- Hiroyuki Yamada
- Department of Nephrology, Kyoto University, Kyoto, Japan,Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Kyoto University, Kyoto, Japan,Institute for the Advanced Study of Human Biology, Kyoto University, Kyoto, Japan
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Papadimitriou-Olivgeris M, Panteli E, Koutsileou K, Boulovana M, Zotou A, Marangos M, Fligou F. Predictors of mortality of trauma patients admitted to the ICU: a retrospective observational study☆. Braz J Anesthesiol 2020; 71:23-30. [PMID: 33712248 PMCID: PMC9523669 DOI: 10.1016/j.bjane.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background and objectives Worldwide, trauma is one of the leading causes of morbidity and mortality. The aim of the present study is to identify the predictors of mortality of trauma patients requiring Intensive Care Unit (ICU) admission. Methods This retrospective study was conducted in the ICU of our institution in Greece during a six-year period (2010–215). Results Among 326 patients, trauma was caused by road traffic accidents in .5%, followed by falls (21.1%) and violence (7.4%). Thirty-day mortality was 27.3%. Multivariate analysis showed that higher New Injury Severity Score (NISS), severe head/neck injury, acute kidney injury, septic shock and hemorrhagic shock were significantly associated with mortality while higher Revised Injury Severity Classification, version II (RISC II) and the administration of enteral nutrition were associated with survival. NISS showed the higher accuracy in predicting 30-day mortality followed by RISC II, while scores based only in physiological variables had lower predictive ability. Conclusions Increased mortality was strongly associated with the severity of the injury upon admission. Traumatic brain injury, septic shock and acute kidney injury have also been found among the strongest predictors of mortality. NISS can be considered as a statistically superior score in predicting mortality of severely injured patients.
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Affiliation(s)
- Matthaios Papadimitriou-Olivgeris
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece; University Hospital of Lausanne, Department of Infectious Diseases, Lausanne, Switzerland; University of Patras, School of Medicine, Division of Infectious Diseases, Patras, Greece.
| | - Eleftheria Panteli
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Kyriaki Koutsileou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Maria Boulovana
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Anastasia Zotou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
| | - Markos Marangos
- University of Patras, School of Medicine, Division of Infectious Diseases, Patras, Greece
| | - Fotini Fligou
- University of Patras, School of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Patras, Greece
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Chico-Fernández M, Barea-Mendoza JA, Ormazabal-Zabala T, Moreno-Muñoz G, Pastor-Marcos D, Bueno-González A, Iglesias-Santiago A, Ballesteros-Sanz MÁ, Pérez-Bárcena J, Llompart-Pou JA. Associated risk factors and outcomes of acute kidney injury in severe trauma: Results from the Spanish trauma ICU registry (RETRAUCI). Anaesth Crit Care Pain Med 2020; 39:503-506. [DOI: 10.1016/j.accpm.2019.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/21/2019] [Accepted: 11/16/2019] [Indexed: 12/20/2022]
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Emigh BJ, Sahi SL, Teal LN, Blake JC, Heron CH, Teixeira PG, Coopwood B, Cardenas TC, Trust MD, Brown CV. Incidence and Risk Factors for Acute Kidney Injury in Severely Injured Patients Using Current Kidney Disease: Improving Global Outcomes Definitions. J Am Coll Surg 2020; 231:326-332. [PMID: 32585304 DOI: 10.1016/j.jamcollsurg.2020.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a significant cause of morbidity and mortality for critically injured trauma patients. The Kidney Disease: Improving Global Outcomes (KDIGO) practice guideline is the most up-to-date classification for AKI. The aims of this study were to determine the incidence and risk factors for AKI in critically injured trauma patients using the current KDIGO definitions. STUDY DESIGN A prospective cohort study was performed at our academic, level 1 trauma center, from September 2017 to August 2018. All adult trauma patients admitted to the surgical ICU were included. The primary outcome was the development of AKI, as defined by KDIGO. Secondary outcomes included hospital and ICU length of stay, ventilator days, and mortality. RESULTS There were 466 patients included and 314 (67%) developed AKI. Those who developed AKI were more often hypotensive on admission (7% vs 2%), had higher Injury Severity Scores (ISS) (19 vs 13), were more likely to have severe injuries to the chest (40% vs 24%) and extremities (20% vs 6%), received transfusion (41% vs 21%), sustained crush injuries (8% vs 1%), received radiocontrast (75% vs 47%), nephrotoxic medication (74% vs 60%), or vasopressors (15% vs 3%). After multivariate analysis, risk factors independently associated with AKI include age, Injury Severity Score (ISS), severe extremity injuries, radiocontrast, and vasopressors. Those who developed AKI had higher mortality (9% vs 2%). CONCLUSIONS Using current KDIGO criteria, the incidence of AKI in critically injured trauma patients was higher than previously reported. Older patients, with more severe injuries to their extremities and chest and who have suffered crush injuries, appear to be the most a risk. AKI in the critically injured patient results in an almost 5-fold increase in mortality.
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Affiliation(s)
- Brent J Emigh
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX.
| | - Saad L Sahi
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Lindsey N Teal
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Jennifer C Blake
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX
| | - Charlotte H Heron
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Pedro G Teixeira
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Ben Coopwood
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Tatiana C Cardenas
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Marc D Trust
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
| | - Carlos Vr Brown
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Austin, TX
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Abstract
PURPOSE OF REVIEW A summary of recent research into the epidemiology, cause, management and outcomes of trauma-associated acute kidney injury (AKI). There is an increasing focus on subtypes of AKI to better target clinical management and future research. RECENT FINDINGS AKI associated with trauma occurs in 20-24% of patients admitted to ICU. On the basis of creatinine and/or urine output, AKI occurs in the first few days of traumatic illness. Although various associations have been identified, shock and high-volume blood transfusion are the most consistent risks for development of trauma-associated AKI. Short-term outcomes appear worse for patients with AKI, but extent of longer term kidney function recovery remains unknown. Recent research in the general critical care population is beginning to better inform AKI management; however, currently, preventive and supportive strategies remain the mainstay of AKI management after trauma. SUMMARY Well-designed, prospective research is required to better understand the phenotype, pathophysiology and recovery trajectory of trauma-associated AKI. Only then can potentially unique therapeutic targets be developed for this common subtype of AKI.
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Bjornstad EC, Muronya W, Smith ZH, Gibson K, Mottl AK, Charles A, Marshall SW, Golightly YM, Munthali CK, Gower EW. Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study. BMC Nephrol 2020; 21:98. [PMID: 32169046 PMCID: PMC7071651 DOI: 10.1186/s12882-020-01755-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/02/2020] [Indexed: 12/18/2022] Open
Abstract
Background Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa. Methods Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI. Results We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n = 4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2–19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies. Conclusions AKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.
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Affiliation(s)
- Erica C Bjornstad
- Department of Pediatrics, Division of Nephrology, University of Alabama Birmingham, 1600 7th Avenue South, Lowder 516, Birmingham, AL, 35233, USA. .,Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.
| | - William Muronya
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Zachary H Smith
- Univeristy of North Carolina Project Malawi, Lilongwe, Malawi.,Division of Pediatric Critical Care Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Keisha Gibson
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Amy K Mottl
- Department of Medicine, Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony Charles
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA.,Malawi Surgical Initiative, Lilongwe, Malawi
| | - Stephen W Marshall
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.,University of North Carolina Injury Prevention Research Center, Carrboro, NC, USA
| | - Yvonne M Golightly
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA.,University of North Carolina Injury Prevention Research Center, Carrboro, NC, USA
| | - Charles K Munthali
- Department of Medicine, Renal Unit, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Emily W Gower
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Public Health, Chapel Hill, NC, USA
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14
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Wu M, Luan YY, Lu JF, Li H, Zhan HC, Chen YH, Zhang F, Tian YY, Yang ZL, Yao YM, Feng YW. Platelet count as a new biomarker for acute kidney injury induced by hemorrhagic shock. Platelets 2019; 31:94-102. [PMID: 30810451 DOI: 10.1080/09537104.2019.1581921] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The aim of this study was to investigate the association between nadir platelet count and acute kidney injury (AKI) or 28-day all-cause mortality induced by hemorrhagic shock (HS), and to determine the cutoff value of nadir platelet count in HS clinical practice. This retrospective study included hospitalized patients enrolled in a tertiary-care teaching hospital from January 1, 2010 to December 31, 2015. Clinical data from HS admitted to the intensive care unit (ICU) were evaluated. Nadir platelet count was defined as the lowest values in the first 48 h. Multivariate logistic regression and Cox proportional hazards regression were used to assess the correlation between nadir platelet count and AKI or 28-day all-cause mortality induced by HS, respectively; the area under receiver operating characteristic (AU-ROC) and Youde's index were used to determine the optimal cutoff value of nadir platelet count. Kaplan-Meier's method and log-rank test were assessed for the 28-day all-cause mortality in AKI and non-AKI groups. Of 1589 patients screened, 84 patients (mean age,37.1 years; 58 males) were included in the primary analysis in which 30 patients with AKI. Multiple logistic results indicated that nadir platelet count was a risk factor of AKI (OR = 0.71,95% confidence interval [CI] 0.54-0.93, P < 0.05). Cox regression analysis revealed that nadir platelet count was independent risk factors for 28-day all-cause mortality (Hazard ratios [HR]0.89,95%CI 0.76-0.99, P < 0.05). Kaplan-Meier curve showed that 28-day all-cause mortality was significantly higher in patients with AKI than non-AKI (P < 0.001).These results suggest that nadir platelet count in the first 48 h is a new biomarker for AKI and 28-day all-cause mortality induced by HS. Moreover, the risk for AKI and 28-day all-cause mortality in HS patients decreased by 29% and 11%, respectively, for every 10 × 109/L increase in platelet count. Additional studies are needed to investigate whether elevation of nadir platelet count reduces the risk in different genders.
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Affiliation(s)
- Ming Wu
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Ying-Yi Luan
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Trauma Research Center, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, China
| | - Jun-Fu Lu
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Department of Critical Care Medicine, Central People's Hospital of Zhanjiang, Zhanjiang, China
| | - Haoli Li
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Hai-Chao Zhan
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Yan-Hong Chen
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Fan Zhang
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Yu-Yu Tian
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
| | - Zi-Long Yang
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Graduate School, Guangdong Medical University, Zhanjiang, China
| | - Yong-Ming Yao
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China.,Trauma Research Center, First Hospital Affiliated to the Chinese PLA General Hospital, Beijing, China
| | - Yong-Wen Feng
- Department of Critical Care Medicine, The Second People's Hospital of Shenzhen & First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen,China
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15
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Søvik S, Isachsen MS, Nordhuus KM, Tveiten CK, Eken T, Sunde K, Brurberg KG, Beitland S. Acute kidney injury in trauma patients admitted to the ICU: a systematic review and meta-analysis. Intensive Care Med 2019; 45:407-419. [PMID: 30725141 DOI: 10.1007/s00134-019-05535-y] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/14/2019] [Indexed: 01/17/2023]
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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Affiliation(s)
- Signe Søvik
- Department of Anaesthesia and Intensive Care, Akershus University Hospital, Lørenskog, Norway. .,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | | | - Kine Marie Nordhuus
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Torsten Eken
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway
| | - Kjetil Gundro Brurberg
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.,Center for Evidence Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Sigrid Beitland
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ullevål, Oslo, Norway.,Renal Research Group Ullevål, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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16
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Skinner DL, Kong VY, de Vasconcellos K, Bruce JL, Bekker W, Laing GL, Clarke DL. Acute Kidney Injury on Presentation to a Major Trauma Service is Associated with Poor Outcomes. J Surg Res 2018; 232:376-382. [DOI: 10.1016/j.jss.2018.06.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/18/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
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17
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Tamura N, Kuriyama A, Kaihara T. Health-related quality of life in trauma patients at 12 months after injury: a prospective cohort study. Eur J Trauma Emerg Surg 2018; 45:1107-1113. [PMID: 30167738 DOI: 10.1007/s00068-018-0993-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/18/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) is increasingly recognized as a benchmark in trauma outcome research, with few studies having evaluated the HRQOL in trauma patients. The aim of our study was to assess the change in trauma patients' HRQOL at 12 months post-injury and to describe their living situation and return to work status. METHODS A prospective cohort study was performed at a Japanese tertiary care hospital from September 2013 to September 2015. The short-form (SF-36) health survey was used at discharge, and 6 and 12 months post-injury. We obtained information regarding living situation at 12 months post-injury. RESULTS Complete data were collected from 129 patients. The median age and injury severity score were 66 years 17, respectively. The physical and role-social component scores improved significantly between hospital discharge and 6 months post-injury. However, the mental component score decreased significantly during this period. There was no significant increase in any of the 3 SF-36 component scores between 6 and 12 months post-injury. At 12 months post-injury, 106 (82%) patients were independent and 15 (12%) patients were dependent on home care services. The return to work rate was 65% (47/72). CONCLUSIONS Our study suggests that the quality-of-life of Japanese trauma patients generally improved over time, but remained lower than the Japanese national average. Most trauma patients return to home and work within 12 months post-injury.
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Affiliation(s)
- Nobuichiro Tamura
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki city, Japan.
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki city, Japan
| | - Toshie Kaihara
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki city, Japan
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18
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Single Graft Utilization From Donors With Severe Acute Kidney Injury After Circulatory Death. Transplant Direct 2018; 4:e355. [PMID: 29707626 PMCID: PMC5908460 DOI: 10.1097/txd.0000000000000768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/29/2017] [Indexed: 12/21/2022] Open
Abstract
Chronic shortages of organs for transplantation have led to the use of marginal kidneys from donors after circulatory death with acute kidney injury (AKI), but the utilization of kidneys with severe AKI is not well established. We retrospectively analyzed eight kidney transplantation (KTx) cases from donation after circulatory death (DCD) with terminal creatinine (t-Cr) concentrations higher than 10.0 mg/dL and/or oliguria for more than 5 days (AKI network criteria: stage III). Although all patients showed delayed graft function, no cases of primary nonfunction (PNF) were found. Five patients maintained stable renal function for approximately 15.5, 10, 10, 5, and 0.5 years after KTx. Only 1 patient showed biopsy-proven acute rejection. Also, 2 patients developed graft failure: one attributable to chronic antibody mediated rejection at 11.3 years after KTx, and one attributable to recurrence of IgA nephropathy at 4.6 years after KTx. Kidneys with AKI stage III yielded great outcomes without the risk of primary nonfunction and rejection. Although the AKI kidneys were associated with delayed graft function, these results suggest that even the most severe kidneys with AKI stage III from DCD donors can be considered a valid alternative for recipients on a waiting list for KTx.
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19
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Wen C, Xue FS, Yang GZ, Liu YY. Assessing incidence and risk factors of acute kidney injury in traumatic patients. Injury 2017; 48:2888-2889. [PMID: 29029955 DOI: 10.1016/j.injury.2017.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/07/2017] [Indexed: 02/02/2023]
Affiliation(s)
- Chao Wen
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Gui-Zhen Yang
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Ya-Yang Liu
- Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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