Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients.
Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients.
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DOI：
10.1097/sla.0b013e3181deb6bc
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发表时间：
2010-07
影响因子：
9
通讯作者：
Moldawer LL
中科院分区：
文献类型：
--
作者：
Bihorac A;Delano MJ;Schold JD;Lopez MC;Nathens AB;Maier RV;Layon AJ;Baker HV;Moldawer LL
在钝性创伤患者的多中心前瞻性队列中确定与急性肾损伤（阿基）相关的临床和基因组特征以及院内死亡风险。在创伤患者中，以血清肌酐（sCr）的微小变化为特征的阿基的不太严重的阶段未得到充分研究。我们对“炎症和宿主对损伤的反应”（Gynecological Grant）数据库进行了二次分析，以纳入无肾脏疾病史的成人钝性创伤患者。阿基由步枪（风险、损伤、衰竭、损失和终末期肾脏）分类定义，该分类要求sCr增加50%，并将患者分为三个严重程度阶段：风险、损伤和衰竭。采用多变量logistic回归分析分析阿基各阶段与住院死亡率之间的相关性。对创伤后12小时内获得的全血白细胞进行全基因组表达分析。982例患者中有26%发生阿基。与未发生阿基的患者相比，AKI患者的医院死亡校正风险高3倍（比值比[OR] 3.05（95%置信区间[CI]，（1.73，TO 5.40））。这种风险在剂量-反应方式中是明显的，与未发生阿基的患者相比，即使轻度阿基患者的死亡OR也为2.57（95% CI，1.19 - 5.50）。全基因组表达分析未能显示其表达可以区分患有和不患有阿基的患者的大量基因。在钝性创伤患者的多中心前瞻性队列中，以sCr微小变化为特征的阿基与医院死亡的独立风险相关。
To determine clinical and genomic characteristics and in-hospital mortality risk associated with acute kidney injury (AKI) in the multicenter prospective cohort of patients with blunt trauma. Less severe stages of AKI characterized by small changes in serum creatinine (sCr) are inadequately studied among trauma patients. We performed a secondary analysis of the “Inflammation and the Host Response to Injury” (GlueGrant) database to include adult blunt trauma patients without history of kidney disease. AKI was defined by the RIFLE (Risk, Injury, Failure, Loss, and End-stage Kidney) classification, which requires a 50% increase in sCr and stratifies patients into three severity stages: risk, injury, and failure. Association between all stages of AKI and in-hospital mortality was analyzed using a multivariable logistic regression analysis. Genome-wide expression analysis was performed on whole blood leukocytes obtained within 12 hours of trauma. AKI occurred in 26% of 982 patients. The adjusted risk for hospital death was three times higher for patients with AKI compared to patients without AKI (odds ratio [OR] 3.05 (95% confidence interval [CI], (1.73, TO 5.40). This risk was evident in a dose-response manner and even patients with mild AKI had OR for dying of 2.57 (95% CI, 1.19 to 5.50) compared to patients without AKI. Genome-wide expression analysis failed to show a significant number of genes whose expression could discriminate among patients with and without AKI. In a multi-center prospective cohort of blunt trauma patients, AKI characterized by small changes in sCr was associated with an independent risk of hospital death.