Primary injuries and secondary organ failures in trauma patients with acute kidney injury treated with continuous renal replacement therapy

Sigrid Beitland; Ingrid Os; Kjetil Sunde

doi:10.1155/2014/235215

Primary injuries and secondary organ failures in trauma patients with acute kidney injury treated with continuous renal replacement therapy

Scientifica (Cairo). 2014:2014:235215. doi: 10.1155/2014/235215. Epub 2014 Dec 23.

Authors

Sigrid Beitland¹, Ingrid Os², Kjetil Sunde¹

Affiliations

¹ Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Postboks 4956, Nydalen, 0424 Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1072, Blindern, 0316 Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1072, Blindern, 0316 Oslo, Norway ; Division of Medicine, Department of Nephrology, Oslo University Hospital, Postboks 4956, Nydalen, 0424 Oslo, Norway.

Abstract

Background. Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) is a severe complication in trauma patients. The aim of the study was to assess primary traumatic injuries and secondary organ failures in severe posttraumatic AKI. Methods. Retrospective review of adult trauma patients admitted to the trauma centre at Oslo University Hospital Ullevål. Injury severity score (ISS) was used to assess the severity of primary injuries, and sequential organ failure assessment (SOFA) score was utilized to measure secondary organ failures. Results. Forty-two (8%) of 506 trauma patients admitted to intensive care unit developed AKI treated with CRRT, whereof 40 (95%) suffered blunt trauma mechanisms. Patients had extensive primary organ injuries with median (interquartile range) ISS 36 (27-49). The majority of the patients had respiratory (93% intubated) and cardiovascular (67% with inotropic and/or vasoactive medication) failure within 24 hours after admission. AKI was often part of multiple organ failure, most frequently respiratory and cardiovascular failure, affecting 33 (75%) and 30 (71%) of the patients, respectively. Conclusion. Trauma patients with AKI undergoing CRRT often had severe primary injuries due to blunt trauma. Most of them suffered from secondary multiple organ failure concomitant to AKI.