The incidence and associations of acute kidney injury in trauma patients admitted to critical care: A systematic review and meta-analysis

作者：Ryan W. Haines, Alexander James Fowler, Christopher J. Kirwan, John Richard Prowle · 发表于：The Journal of Trauma: Injury, Infection, and Critical Care · 年份：2018 · DOI：10.1097/ta.0000000000002085 · 被引用次数：71 · 研究领域：Acute Kidney Injury Research、Abdominal Trauma and Injuries、Trauma, Hemostasis, Coagulopathy, Resuscitation

BACKGROUND: As more patients are surviving the initial effects of traumatic injury clinicians are faced with managing the systemic complications of severe tissue injury. Of these, acute kidney injury (AKI) may be a sentinel complication contributing to adverse outcomes. OBJECTIVE: To establish the incidence of AKI in patients admitted to critical care after major trauma, to explore any risk factors and to evaluate the association of AKI with outcomes. DATA SOURCES: Systematic search of MEDLINE, Excerpta Medica database and Cochrane library from January 2004 to April 2018. STUDY SELECTION: Studies of adult major trauma patients admitted to critical care that applied consensus AKI criteria (risk injury failure loss end stage [RIFLE], AKI network, or kidney disease improving global outcomes) and reported clinical outcomes were assessed (PROSPERO Registration: CRD42017056781). Of the 35 full-text articles selected from the screening, 17 (48.6%) studies were included. DATA EXTRACTION AND SYNTHESIS: We followed the PRISMA guidelines and study quality was assessed using the Newcastle-Ottawa score. The pooled incidence of AKI and relative risk of death were estimated using random-effects models. MAIN OUTCOMES AND MEASURES: Incidence of AKI was the primary outcome. The secondary outcome was study-defined mortality. RESULTS: We included 17 articles describing AKI outcomes in 24,267 trauma patients. The pooled incidence of AKI was 20.4% (95% confidence interval [CI], 16.5-24.9). Twelve ...