외상 후 급성 신손상의 위험인자와 임상경과

Abstract

Introduction: Acute kidney injury (AKI) is an uncommon but serious complication after trauma. The objective of this study was to evaluate the clinical characteristics, risk factors and outcomes of AKI after trauma. Materials and Methods: We performed a retrospective cohort study from January 2012 to Decem¬ber 2013 with 386 trauma patients who visited emergency department in Asan Medical Center. Among them, 322 patients were enrolled. Patients were divided into AKI group and no AKI group. Regression analysis was performed to identify factors associated with AKI development. Results: The overall incidence of AKI was 6% (21/322). There was no difference in patients` age, sex and body weight between both groups. Whereas there was significantly difference in Injury Severity Score (ISS) (16.4 ± 8.8 vs. 29.8 ± 14.9, p<0.01), GCS (14.1 ± 2.2 vs. 11.7 ± 4.3, p=0.02), presence of shock (11.6% vs. 57%, p<0.01), transfusion (19.6% vs. 66%, p<0.01), lactic acid (2.8 ± 2.2 vs. 5.5 ± 4.1, p=0.01) and severe rhabdomyolysis (CK>5,000IU/L) (11% vs. 57%, p<0.01). In multivariate analysis, independent risk factors associated with AKI after trauma were ISS [odds ratio (OR)=1.065, p<0.01], presence of shock (OR=3.949, p=0.012), and severe rhabdomyolysis (OR=4.475, p<0.01). Patients in AKI group were classified according to RIFLE criteria as Risk in 9 cases (43%), Injury in 3 (14%), Failure in 7 (33%), Loss in 0 (0%) and End-stage in 2 (10%). Renal replacement therapy (RRT) was required for 10 patients (47%) in AKI group and 4 of them (40%) undergone successful weaning. Hospital mortality rate was higher in AKI group (5/21, 23%) than no AKI group (3/301, 1%) (p<0.01). Conclusion: The de¬velopment of AKI was associated with severity of trauma. Furthermore, the AKI patients after trauma was refer to increase mortality.