Acute Crit Care.  2023 Feb;38(1):95-103. 10.4266/acc.2022.01046.

Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma

• Lee K
• Ryu D
• Kim H
• Park S
• Lee S
• Park C
• Kim G
• Kim S
• Lee N

• KMID: 2540319
• DOI: http://doi.org/10.4266/acc.2022.01046

Abstract

Background
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE).
Methods
We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs.
Results
The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage.
Conclusions
In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Keyword

acute kidney injury; intensive care unit; mortality; reference creatinine; trauma patient

Figure

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  Figure 1. Flowchart of the study. ISS: Injury Severity Score; ICU: intensive care unit; CKD: chronic kidney disease.

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  Figure 2. Comparison of estimated serum creatinine 75 (eSCr75) modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine, and first-day nadir creatinine area under the curve (AUC) for predicting mortality (A) and the need for renal replacement therapy (B). Values are presented as AUC (95% confidence interval).

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  Figure 3. Mortality (A) and the need for renal replacement therapy (B) by acute kidney injury (AKI) stage. eSCr75: estimated serum creatinine 75; MDRD: modification of diet in renal disease.

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