Abstract：Objective To evaluate the incidence,severity,risk tactors and impact to prognosis of acute kidney injury (AKI) in patients with severe traumatic brain injury (sTBI) by using acute kidney injury network (AKIN) classification system. Methods A retrospective analysis was carried out in 136 patients with sTBI hospitalized between January 2007 and May 2011.Demographic data,admission evaluation (whether with hernia or not on admission,systolic pressure and mean arterial blood pressure,serum creatinine and urea nitrogen,and blood glucose),outcome at 6 months post-injury and mortality were collected.Renal function was assessed using AKIN criteria.The patients were divided into two groups based on the presence or absence of AKI (non-AKI group and AKI group).According to the severity of AKI,AKI group was further classified as AKI grade 1 group,AKI grade 2 group and AKI grade 3 group.The differences among groups were analyzed. Results According to AKIN classification system,31 (23％) out of the 136 patients were diagnosed as being with AKI,including 21 cases (68％) in AKI grade 1 group and 10 cases (32％) in AKI grade 2 and 3 groups.The patients at older age and with lower Glasgow coma scale (GCS) on admission,higher levels of serum creatinine and blood urea nitrogen on admission were prone to AKI.As compared with TBI patients with normal renal function,TBI patients associated with AKI had higher mortality and worse outcome. Conclusions AKI is a common complication of patients with sTBI.AKIN classification system can early diagnose AKI in sTBI patients and may contribute to improvement of the outcome.
$author.xingMing_EN,$author.xingMing_EN,$author.xingMing_EN et al. Acute kidney injury network classification system for evaluation of acute kidney injury in patients with severe traumatic brain injury[J]. CHINESE JOURNAL OF TRAUMA, 2013, 29(11): 1053-1057.
［1］Sugerman DE,Xu L,Pearson WS,et al.Patients with severe traumatic brain injury transferred to a Level I or II trauma center:United States,2007 to 2009.J Trauma Acute Care Surg,2012,73(6):1491-1499.
［2］Zygun DA,Doig CJ,Gupta AK,et al.Non-neurological organ dysfunction in neurocritical care.J Crit Care.2003,18(4):238-244.
［3］Agrawal A,Galwankar S,Kapil V,et al.Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in Maharashtra,India.2007-2009.Int J Crit Illn Inj Sci,2012,(3):167-171.
［4］Murray GD,Butcher I,McHugh GS,et al.Multivariable prognostic analysis in traumatic brain injury:results from the IMPACT study.J Neurotrauma,2007,24(2):329-337.
［5］Lefering R,Paffrath T,Linker R,et al.Head injury and outcome—what influence do concomitant injuries have?J Trauma,2008,65(5):1036-1043.
［6］Coca SG,Peixoto AJ,Garg AX,et al.The prognostic importance of a small acute decrement in kidney function in hospitalized patients:a systematic review and meta-analysis.Am J Kidney Dis,2007,50(5):712-720.
［7］Molitoris BA,Levin A,Warnock DG,et al.Improving outcomes of acute kidney injury:report of an initiative.Nat Clin Pract Nephrol,2007,3(8):439-442.
［8］Mehta RL,Kellum JA,Shah SV,et al.Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury.Crit Care,2007,11(2):R31.
［9］Moore EM,Bellomo R,Nichol A,et al.The incidence of acute kidney injury in patients with traumatic brain injury.Ren Fail,2010,32(9):1060-1065.
［10］Nijboer WN,Ottens PJ,van Dijk A,et al.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(4):1155-1161.
［11］Bagshaw SM,George C,Gibney RT,et al.A multi-center evaluation of early acute kidney injury in critically ill trauma patients.Ren Fail,2008,30(6):581-589.
［12］Costantini TW,Fraga G,Fortlage D,et al.Redefining renal dysfunction in trauma: implementation of the Acute Kidney Injury Network staging system.J Trauma,2009,67(2):283-287.
［13］Zacharia BE,Ducruet AF,Hickman ZL,et al.Renal dysfunction as an independent predictor of outcome after aneurysmal subarachnoid hemorrhage:a single-center cohort study.Stroke,2009,40(7):2375-2381.
