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Acute Kidney Injury in Patients with Severe Traumatic Brain Injury: Implementation of the Acute Kidney Injury Network Stage System

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Abstract

Background

There is limited information on the incidence and effect of acute kidney injury (AKI) in patients with severe traumatic brain injury (TBI), although AKI may affect outcome. Recently, acute kidney injury network (AKIN) classification has been widely accepted as a consensus definition for AKI. The aim of this study is to estimate the frequency and level of severity of AKI in patients with severe TBI by using AKIN criteria and to study whether AKI affects outcome.

Methods

The authors retrospectively identified a total of 136 patients with severe TBI admitted to the neurosurgical center during a 3-year period ending May 2010. Demographic data, severity of TBI, serum creatinine, urine output, outcome at 6 month, and death were collected. Renal function was assessed by using AKIN criteria.

Results

Thirty-one patients (23%) were classified as having AKI by using AKIN criteria during their hospitalization. Of them, 21 patients (68%) were stratified as stage 1, 7 patients (22%) as stage 2, and 3 patients (10%) as stage 3. Patients who developed AKI were older, had lower Glasgow coma scale at admission, and had higher level of admission serum creatinine and blood urea nitrogen. Patients with AKI had higher mortality and worse outcome when compared with patients with normal renal function. Furthermore, patients with mild renal dysfunction (stage 1 AKI) are also found having increased mortality and worse long-term outcome, compared with patients without renal dysfunction.

Conclusion

It is demonstrated using the newly defined AKIN criteria for renal dysfunction that AKI is a relatively common feature in patients with severe TBI, and even seemingly insignificant decrease in renal function may be associated with worse outcome. This study highlights the importance of close surveillance of renal function and stresses the value of renal hygiene in the severe TBI population.

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References

  1. Gruber A, Reinprecht A, Illievich UM, Fitzgerald R, Dietrich W, Czech T, Richling B. Extracerebral organ dysfunction and neurologic outcome after aneurismal subarachnoid hemorrhage. Crit Care Med. 1999;27:505–14.

    Article  PubMed  CAS  Google Scholar 

  2. Zygun DA, Doig CJ, Gupta AK, Whiting G, Nicholas C, Shepherd E, Conway-Smith C, Menon DK. Non-neurological organ dysfunction in neurocritical care. J Crit Care. 2003;18:238–44.

    Article  PubMed  Google Scholar 

  3. Wahlstrom MR, Olivecrona M, Nystrom F, Koskinen LO, Naredi S. Fluid therapy and the use of albumin in the treatment of severe traumatic brain injury. Acta Anaesthesiol Scand. 2009;53:18–25.

    Article  Google Scholar 

  4. Zygun D, Kortbeek J, Fick G, Laupland KB, Doig CJ. Non-neurological organ dysfunction in severe traumatic brain injury. Crit Care Med. 2005;33:654–60.

    Article  PubMed  Google Scholar 

  5. Schirmer-Mikalsen K, Vik A, Gisvold SE, Skandsen T, Hynne H, Klepstad P. Severe head injury: control of physiological variables, organ failure and complications in the intensive care unit. Acta Anaesthesiol Scand. 2007;51:1194–201.

    PubMed  CAS  Google Scholar 

  6. Mascia L, Sakr Y, Pasero D, Payen D, Reinhart K, Vincent JL. Sepsis occurrence in acutely III patients (SOAP) investigators. Extracranial complications in patients with acute brain injury: a post-hoc analysis of the SOAP study. Intensive Care Med. 2008;34:720–7.

    Article  PubMed  Google Scholar 

  7. Lefering R, Paffrath T, Linker R, Bouillon B. Neugebauer EA; Deutsche Gesellschaft für Unfallchirurgie/German Society for Trauma Surgery. Head injury and outcome–what influence do concomitant injuries have? J Trauma. 2008;65:1036–43.

    Article  PubMed  Google Scholar 

  8. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.

    Article  PubMed  CAS  Google Scholar 

  9. Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638–52.

    Article  PubMed  CAS  Google Scholar 

  10. Levy MM, Macias WL, Vinent JL, Russell JA, Silva E, Trzaskoma B, Williams MD. Early changes in organ function predict eventual survival in severe sepsis. Crit Care Med. 2005;33:2194–201.

    Article  PubMed  Google Scholar 

  11. Coca SG, Peixoto AJ, Garg AX, Krumholz HM, Parikh CG. The prognosis importance of a small acute decrement in kidney function in hospitalized patients: a systematic review and meta-analysis. Am J Kidney Dis. 2007;50:712–20.

    Article  PubMed  CAS  Google Scholar 

  12. Mehta RL, Kellum JA, Shah SV, et al. Acute kidney injury network: report of an initiative to improve outcome in acute kidney injury. Crit Care. 2007;11:R31.

    Google Scholar 

  13. Barrants F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA. Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med. 2008;36:1397–403.

    Article  Google Scholar 

  14. Molitoris BA, Levin A, Warnock DG, et al. Acute kidney injury network working group. Improving outcomes of acute kidney injury: report of an initiative. Nat Clin Pract Nephrol. 2007;3:439–42.

    Article  PubMed  Google Scholar 

  15. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure-definition, outcome measures, animal models, fuild therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care. 2004;8:R204–12.

    Article  PubMed  Google Scholar 

  16. Costantini TW, Fraga G, Fortlage D, Wynn S, Fraga A, Lee J, Doucet J, Bansal V, Coimbra R. Redefining renal dysfunction in trauma: implementation of the acute kidney injury network stage system. J Trauma. 2009;67:283–8.

    Article  PubMed  Google Scholar 

  17. Zacharia BE, Ducruet AF, Hickman ZL, Grobelny BT, Fernandez L, Schmidt JM, Narula R, Ko LN, Cohen ME, Mayer SA, Connolly ES Jr. Renal dysfunction as an independent predictor of outcome after aneurysmal subarachnoid hemorrhage: a single-center cohort study. Stroke. 2009;40:2375–81.

    Article  PubMed  Google Scholar 

  18. Moore EM, Bellomo R, Nichol A, Harley N, MacIsaac C, Cooper J. The incidence of acute kidney injury in patients with traumatic brain injury. Ren Fail. 2010;30:1060–5.

    Article  Google Scholar 

  19. Ponte B, Felipe CA, Tenorio MT, Liano F. Long-term functional evolution after an acute kidney injury: a 10-year study. Nephrol Dial Transpl. 2008;23:3859–66.

    Article  Google Scholar 

  20. Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, Macleod A. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007;18:1292–8.

    Article  PubMed  CAS  Google Scholar 

  21. Chen YC, Jeng CC, Tian YC, Chang MY, Lin CY, Chang CC, Lin HC, Fang JT, Yang CW, Lin SM. Rifle classification for predicting in-hospital mortality in critically ill sepsis patients. Shock. 2009;31:139–45.

    Article  PubMed  Google Scholar 

  22. Nijboer WN, Ottens PJ, van Dijk A, van Goor H, Ploeg RJ, Leuvenink HG. Donor pretreatment with carbamylated erythropoietin in a brain death model reduces inflammation more effectively than erythropoietin while preserving renal function. Crit Care Med. 2010;38:1155–61.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

The authors would like to thank Yu Ting MD (Abbott diagnostics division, China) for statistical advice.

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Authors and Affiliations

  1. Department of Neurosurgery, Rui Jin Hospital, Shanghai Jiao Tong University, Shanghai, 200025, People’s Republic of China

    Ning Li, Wei-Guo Zhao & Wei-Feng Zhang

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  1. Ning Li
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  2. Wei-Guo Zhao
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  3. Wei-Feng Zhang
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Correspondence to Wei-Guo Zhao.

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Li, N., Zhao, WG. & Zhang, WF. Acute Kidney Injury in Patients with Severe Traumatic Brain Injury: Implementation of the Acute Kidney Injury Network Stage System. Neurocrit Care 14, 377–381 (2011). https://doi.org/10.1007/s12028-011-9511-1

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  • DOI: https://doi.org/10.1007/s12028-011-9511-1

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