Factors Predicting the Severity of Acute Kidney Injuries in Trauma Patients within 48 Hours
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Keywords:
acute kidney injury, age; co-morbidity, level of consciousness, severity of injury, systematic inflammatory response syndromeAbstract
Objective: To examine the predictive power of age, comorbidity, severity of injury, level of consciousness, and systematic inflammatory response syndrome on trauma patients within 48 hours of receiving acute kidney injuries.
Design: Predictive correlation research.
Methodology: The subjects were 170 trauma patients receiving treatment in the intensive care units of Pattani Hospital, Yala Regional Hospital, Naradhiwas Rajanagarindra Hospital, and Su-ngaikolok Hospital. The data-gathering instruments were 1) a demographic record form; 2) the Injury Severity Score (ISS); 3) the Glasgow Coma Score (GCS), 4) a co-morbidity assessment form; 5) the Systematic Inflammatory Response Syndrome Score (SIRS Score); and 6) the Kidney Disease Improving Global Outcomes Clinical Practice Guideline (KDIGO). The correlations were analysed using Point Bi-serial Correlation, whilst predictive power was examined using Logistic Regression Analysis.
Results:The majority of the subjects (78.8%) were male, averagely aged 39.58 years (SD = 17.37). One-third (30%) of the subjects displayed co-morbidity, and nearly half were suffering from severe injuries and had a moderate level of consciousness (47.6% and 46.5%, respectively). The systematic inflammatory response syndrome was detected in 86.5% of the subjects. On the other hand, acute kidney injuries were found only in 11.8% of the subjects. Based on the results, the severity of injury and systematic inflammatory response syndrome were signifcant factors jointly predicting up to 30% of acute kidney injury incidences in trauma patients within the frst 48 hours of injury (Nagelkerke R2 = .30).
Recommendations:It is highly recommended that nurses thoroughly assess trauma patients’ AKI within the frst 48 hours of injury. Nurses also should use the information on the patients’ injury severity and SIRS for early monitoring and prevention of the development of AKI.
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References
2016 [cited 2017 Jul 1]. Available from: URL:https://www.thaincd.com. (in Thai)
2. Road Accident Data Center. Annual Data year [internet]. 2017. [cited 2017 Sep 26] Available from: URL:
https://www.thairsc.com (in Thai)
3. Kaewnuy S. The South Thailand/Patani insurgency 2016: the chance of transition from a peaceful “struggle” to a “weapon” [internet] 2017 [cited 2017 Aug 9]. Available from: URL: www.deepsouthwatch. org/node/10037 (in Thai)
4. Katsakun A, Thosingha O, Chayaput P, Chaotawee D. Factors predicting injury outcome in critical phase among adults with traumatic injuries. TJNC 2012;26(4):30-42. (in Thai)
5. Baitello AL, Marcatto G, Yagi RK. Risk factors for injury acute renal in patients with severe trauma and
its effect on mortality. J Bras Nefrol 2013;35:127-31.
6. Bihorac A, Delano MJ, Schold JD, Lopez MC, Nathens AB, Maier RV, et al. Incidence clinical predictors genomics and outcome of acute kidney injury among trauma patients. Ann Surg 2010;252:158–65. doi:10.1097/SLA.0b013e3181deb6bc140
7. Santos PR, Monteiro DLS. Acute kidney injury in an intensive care unit of a general hospital with emergency
room specializing in trauma: an observational prospective study. BMC Nephrol 2015;16(1):30.doi:10.1186/s12882-015-0026-4.
8. Lai WH, Rau CS, Wu SC, Chen YC, Kuo PJ, Hsu SY, et al. Post-traumatic acute kidney injury: a cross-sectional study of trauma patients. Scand J Trauma Resusc Emerg Med 2016;24(136):1-7.
9. Ramtinfar S, Chabok SY, Chari AJ, Reihanian Z, Leili EK, Alizadeh A. Kidney disease improving global outcome for predicting acute kidney injury in traumatic brain injury patients. JACME 2016;6(4):90-4. doi:https://dx.doi.org/10.1016/j.jacme. 2016.09.004
10. Poolaireab P, Danadutsadeekul S, Chanruangvanich W, Kongsayreepong S, The relationships among comorbidity, intraoperative conditions, systemic inflammatory response syndrome and acute kidney injury of critical patients in frst 72 hours after major surgery. J Nurs Sci 2016;34(1):107-17. (in Thai)
11. Tasanarong A. (Eds). Acute kidney injury. Bangkok: Folk Doctor; 2014. (in Thai)
12. Baker SP, O’neill B, Haddon WJ, Long WB. The injury severity score: a method for describing patients
with multiple injuries and evaluating emergency care.J Trauma Acute Care 1974;14(3):187-96.
13. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Bain LW, Gann DS, et al. A new characterization of
injury severity. J Trauma Acute Care 1990;30(5): 539-46.
14. Teasdale G, Jennett B. Assessment of coma and i m p a u r e d c o n s c i o u s m e s s . T h e L a n c e t
1974;304(7872): 81-84. doi:https://dx.doi. org/10.1016/S0140-6736(74)91639-0
15. Teasdale GM, Murray G, Anderson E, Mendelow AD, MacMillan R, Jennett B, Brookes M. Risks of
acute traumatic intracranial haematoma in children and adults: implications for managing head injuries. B r i t M e d J 1 9 9 0 ; 3 0 0 ( 6 7 2 1 ) : 3 6 3 - 7 .doi:10.1136/bmj.300.6721. 363
16. Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, et al. Procalcitonin, interleukin
6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after
major surgery. Brit J Aesthet 2005;94(6):767-3. doi:10.1093/bja/ aei143
17. Kidney Disease Improving Global Outcomes (KDIGO) acute kidney injury work group. KDIGO clinical
practice guideline for acute kidney injury. Kidney Int Suppl 2012;2 Suppl:1–38.
18. Rojanakitamnuay S. Signing consent to legally enforceable patients in case their parents fail to sign. Dunlaphãha
2011;58:144-8. (in Thai)
19. Li M, Zhao Z, Yu G, Zhang J. Epidemiology of traumatic brain injury over the world: A systematic review. Austin Neurol & Neurosci 2016;1(2):1-14.
20. Balk RA. Systemic inflammatory response syndrome (SIRS): Where did it come from and is it still relevant
today? Virulence 2014;5(1):20-6.
21. Maiwall R, Shasthry SM, Sharma M, Sarin SK. SIRS at admission is a predictor of AKI development and
mortality in hospitalized patients with severe alcoholic hepatitis. J Hepatol 2014;60(1):S59.
22. Fang L, You H, Chen B, Xu Z, Gao L, Liu J, et al. Mannitol is an independent risk factor of acute kidney
injury after cerebral trauma: a case–control study. Renal Failure 2010;32(6): 673-9. doi:10.3109
/0886022X.2010.486492
23. Norasan S, Saimai P, Unhasuta K, Keskaew C. Quality care of trauma patients at resuscitation unit
in the university hospital. J Public Health 2016;46(3):223-35. (in Thai)
24. Wijdicks EF, Bamlet Maramattom BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol 2005;58(4):585-93.
