High risk of acute kidney injury in Malawian trauma patients: a prospective observational cohort study

被引:6
作者
Bjornstad, Erica C. [1 ]
Smith, Zachary H. [2 ,3 ]
Muronya, William [4 ]
Munthali, Charles K. [5 ]
Mottl, Amy K. [6 ]
Marshall, Stephen W. [7 ,8 ]
Golightly, Yvonne M. [7 ,8 ]
Gibson, Keisha [6 ]
Charles, Anthony [9 ,10 ]
Gower, Emily W. [8 ]
机构
[1] Univ Alabama Birmingham, Dept Pediat, Div Nephrol, 1600 7th Ave South,Lowder 516, Birmingham, AL 35233 USA
[2] Univ N Carolina, Project Malawi, Lilongwe, Malawi
[3] Stanford Univ, Div Pediat Crit Care Med, Sch Med, Stanford, CA USA
[4] Kamuzu Cent Hosp, Dept Surg, Lilongwe, Malawi
[5] Kamuzu Cent Hosp, Dept Med, Renal Unit, Lilongwe, Malawi
[6] Univ N Carolina, Dept Med, Div Nephrol & Hypertens, Chapel Hill, NC USA
[7] Univ N Carolina, Injury Prevent Res Ctr, Chapel Hill, NC USA
[8] Univ N Carolina, Depa Rtment Epidemiol, Hill Gillings Sch Global Publ Hlth, Chapel Hill, NC USA
[9] Univ N Carolina, Dept Surg, Chapel Hill, NC USA
[10] Malawi Surg Initiat, Lilongwe, Malawi
关键词
Trauma; Acute kidney injury; Africa; TRANSFUSION; SCORE; AKI;
D O I
10.1186/s12882-021-02564-y
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Trauma is a common cause of acute kidney injury (AKI). Yet little data exist regarding trauma-related-AKI in low-resourced settings, where the majority of deaths from AKI and trauma occur. We prospectively evaluated epidemiology of AKI in hospitalized Malawian trauma patients. Methods AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes (KDIGO) criteria. Those with AKI were followed up 3-6 months later to determine persistent kidney abnormalities. We calculated univariate statistics with Wilcoxon rank sum tests, Fisher's exact, and chi-square tests to compare those with and without AKI. Multivariate log-risk regression modelling was used to determine risk ratios (RR) and 95% confidence intervals (CI) for AKI development. Results Of 223 participants, 14.4% (n = 32) developed AKI. Most patients were young (median age 32) males (n = 193, 86.5%) involved in road traffic injuries (n = 120, 53.8%). After adjusting for confounders, those with severe anemia during their admission were 1.4 times (RR 1.4, 95% CI 1.1-1.8) more likely to develop AKI than those without. Overall mortality was 7.6% (n = 17), and those who developed AKI were more likely to die than those who did not (18.8% vs 5.6%, p-value = 0.02). Almost half of those with AKI (n = 32) either died (n = 6) or had persistent kidney dysfunction at follow-up (n = 8). Conclusion In one of the few African studies on trauma-related AKI, we found a high incidence of AKI (14.4%) in Malawian trauma patients with associated poor outcomes. Given AKI's association with increased mortality and potential ramifications on long-term morbidity, urgent attention is needed to improve AKI-related outcomes.
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页数:10
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