Abstract
Background
Post-traumatic acute kidney injury has occurred in every major military conflict since
its initial description during World War II. To ensure the proper treatment of combat
casualties, early detection is critical. This study therefore aimed to investigate
combat-related post-traumatic acute kidney injury in recent military conflicts, used
machine learning algorithms to identify clinical and biomarker variables associated
with the development of post-traumatic acute kidney injury, and evaluated the effects
of post-traumatic acute kidney injury on wound healing and nosocomial infection.
Methods
We conducted a retrospective clinical cohort review of 73 critically injured US military
service members who sustained major combat-related extremity wounds and had collected
injury characteristics, assayed serum and tissue biopsy samples for the expression
of protein and messenger ribonucleic acid biomarkers. Bivariate analyses and random
forest recursive feature elimination classification algorithms were used to identify
associated injury characteristics and biomarker variables.
Results
The incidence of post-traumatic acute kidney injury was 20.5%. Of that, 86% recovered
baseline renal function and only 2 (15%) of the acute kidney injury group required
renal replacement therapy. Random forest recursive feature elimination algorithms
were able to estimate post-traumatic acute kidney injury with the area under the curve
of 0.93, sensitivity of 0.91, and specificity of 0.91. Post-traumatic acute kidney
injury was associated with injury severity score, serum epidermal growth factor, and
tissue activin A type receptor 1, matrix metallopeptidase 10, and X-C motif chemokine
ligand 1 expression. Patients with post-traumatic acute kidney injury exhibited poor
wound healing and increased incidence of nosocomial infections.
Conclusion
The occurrence of acute kidney injury in combat casualties may be estimated using
injury characteristics and serum and tissue biomarkers. External validations of these
models are necessary to generalize for all trauma patients.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Post-traumatic acute renal failure.Bull N Y Acad Med. 1979; 55: 150-162
- Post-traumatic acute renal failure in combat casualties: A historical review.Mil Med. 1984; 149: 117-124
- Early acute kidney injury in military casualties.J Trauma Acute Care Surg. 2015; 78: 988-993
- Acute kidney injury in critically injured combat veterans: a retrospective cohort study.Am J Kidney Dis. 2016; 68: 564-570
- Post-traumatic acute renal failure in Vietnam: a milestone in progress.Conn Med. 1974; 38: 7-9
Waikar SS, Bonventre JV. Acute kidney injury. Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J, editors. Harrison's principles of internal medicine, 19e. New York: McGraw-Hill; 2015.
- International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology.Lancet. 2015; 385: 2616-2643
- Long-term risk of mortality and other adverse outcomes after acute kidney injury: a systematic review and meta-analysis.Am J Kidney Dis. 2009; 53: 961-973
- Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.J Am Soc Nephrol. 2005; 16: 3365-3370
- Incidence and associations of acute kidney injury after major abdominal surgery.Intensive Care Med. 2016; 42: 521-530
- Acute kidney injury is associated with increased long-term mortality after cardiothoracic surgery.Circulation. 2009; 119: 2444-2453
- 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: 30
- Risk prediction models for acute kidney injury in critically ill patients: opus in progressu.Nephron. 2018; 140: 99-104
- The economic consequences of acute kidney injury.Nephron. 2017; 137: 297-301
- Post-traumatic acute renal failure in Vietnam. A comparison with the Korean war experience.Johns Hopkins Med J. 1969; 124: 95-105
- Contribution of acute kidney injury toward morbidity and mortality in burns: a contemporary analysis.Am J Kidney Dis. 2007; 49: 517-523
- Acute renal failure in critically ill patients: a multinational, multicenter study.JAMA. 2005; 294: 813-818
- The incidence and outcomes of acute kidney injury amongst patients admitted to a level I trauma unit.Injury. 2014; 45: 259-264
- A multi-center evaluation of early acute kidney injury in critically ill trauma patients.Ren Fail. 2008; 30: 581-589
- Risk factors for injury acute renal in patients with severe trauma and its effect on mortality [in Portuguese].J Bras Nefrol. 2013; 35: 127-131
- Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients.Ann Surg. 2010; 252: 158-165
- African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients.J Crit Care. 2012; 27: 496-504
- Acute kidney injury in trauma patients admitted to critical care: Development and validation of a diagnostic prediction model.Sci Rep. 2018; 8: 3655
- Pathophysiology of ischemic acute kidney injury.Nat Rev Nephrol. 2011; 7: 189-200
- Molecular determinants of acute kidney injury.J Inj Violence Res. 2015; 7: 75-86
- Prediction models for AKI will they result in improved outcomes for AKI?.Clin J Am Soc Nephrol. 2019; 14: 488-490
- Systemic inflammation after trauma.Injury. 2007; 38: 1336-1345
- Inflammatory biomarkers in combat wound healing.Ann Surg. 2009; 250: 1002-1007
- Acute kidney injury is associated with early cytokine changes after trauma.J Trauma Acute Care Surg. 2013; 74: 1005-1013
- Management of acute kidney injury: core curriculum 2018.Am J Kidney Dis. 2018; 72: 136-148
- Early nephrologist involvement in hospital-acquired acute kidney injury: a pilot study.Am J Kidney Dis. 2011; 57: 228-234
- Nephrology referral and outcomes in critically ill acute kidney injury patients.PLoS One. 2013; 8e70482
- Prevention of cardiac surgery-associated acute kidney injury.Curr Opin Anaesthesiol. 2017; 30: 76-83
- Improving acute kidney injury diagnostics using predictive analytics.Curr Opin Crit Care. 2015; 21: 473-478
- The definition and detection of acute kidney injury.J Ren Inj Prev. 2014; 3: 21-25
- A clinically applicable approach to continuous prediction of future acute kidney injury.Nature. 2019; 572: 116-119
- Predicting acute kidney injury: current status and future challenges.J Nephrol. 2018; 31: 209-223
- Soluble urokinase receptor and acute kidney injury.N Engl J Med. 2020; 382: 416-426
- Biomarker-guided intervention to prevent acute kidney injury after major surgery: The Prospective Randomized BigpAK Study.Ann Surg. 2018; 267: 1013-1020
- KDIGO clinical practice guidelines for acute kidney injury.Nephron Clin Pract. 2012; 120: c179-c184
- Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review.Ann Intern Med. 2012; 156: 785-795
- Osteogenic gene expression correlates with development of heterotopic ossification in war wounds.Clin Orthop Relat Res. 2014; 472: 396-404
- Decision variants for the automatic determination of optimal feature subset in RF-RFE.Genes (Basel). 2018; 9: 301
- Assessing the performance of prediction models: a framework for traditional and novel measures.Epidemiology. 2010; 21: 128-138
- Acute posttraumatic renal failure: a multicenter perspective.J Am Soc Nephrol. 2011; 31e77376
- Acute kidney injury following severe trauma: risk factors and long-term outcome.J Trauma Acute Care Surg. 2015; 79: 407-412
- The cellular, immune, and metabolic response to trauma.Crit Rev Clin Lab Sci. 1998; 35: 59-112
- Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.J Trauma. 2009; 66: 1616-1624
- Early and vigorous fluid resuscitation prevents acute renal failure in the crush victims of catastrophic earthquakes.J Am Soc Nephrol. 2004; 15: 1862-1867
- Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio.Crit Care Med. 2011; 39: 1507-1513
- Clinical consequences of acute kidney injury.Contrib Nephrol. 2011; 174: 56-64
- Cytokines in acute kidney injury (AKI).Clin Nephrol. 2011; 76: 165-173
- Acute renal failure: determinants and characteristics of the injury-induced hyperinflammatory response.Am J Physiol Ren Physiol. 2006; 291: F546-F556
- Interleukin-3 prevents cellular death induced by oxidative stress in HEK293 cells.J Cell Biochem. 2017; 118: 1330-1340
- Interleukin-3 prevents neuronal death induced by amyloid peptide.BMC Neurosci. 2007; 8: 82
- Role of epidermal growth factor receptor in acute and chronic kidney injury.Kidney Int. 2013; 83: 804-810
- Epidermal growth factor receptor signaling in the kidney key roles in physiology and disease.Hypertension. 2008; 52: 987-993
- Epidermal growth factor and kidney disease: A long-lasting story.Kidney Int. 2016; 89: 985-987
- Prevalence and risk factors for kidney stones in fibrodysplasia ossificans progressiva.Bone. 2018; 109: 120-123
- Matrix metalloproteinase-9, 10, and stress hyperglycaemia in acute kidney injury.Eur J Clin Invest. 2018; 48e12963
- Chemokines in renal injury.J Am Soc Nephrol. 2011; 22: 802-809
- The development of a machine learning inpatient acute kidney injury prediction model.Crit Care Med. 2018; 46: 1070-1077
- A risk prediction score for acute kidney injury in the intensive care unit.Nephrol Dial Transplant. 2017; 32: 814-822
- Development of a risk stratification-based model for prediction of acute kidney injury in critically ill patients.Medicine (Baltimore). 2019; 98e16867
- Systematic review of prognostic prediction models for acute kidney injury (AKI) in general hospital populations.BMJ Open. 2017; 7e016591
- Development and validation of quick acute kidney injury-score (q-AKI) to predict acute kidney injury at admission to a multidisciplinary intensive care unit.PLoS One. 2019; 14e0217424
- AKIpredictor, an online prognostic calculator for acute kidney injury in adult critically ill patients: development, validation and comparison to serum neutrophil gelatinase-associated lipocalin.Intensive Care Med. 2017; 43: 764-773
- Biomarkers in acute kidney injury—Pathophysiological basis and clinical performance.Acta Physiol (Oxf). 2017; 219: 554-572
- Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury.Crit Care. 2013; 17: R25
Article info
Publication history
Published online: June 27, 2020
Accepted:
April 30,
2020
Identification
Copyright
Published by Elsevier Inc.
