Choice of Reference Creatinine for Post-Traumatic Acute Kidney Injury Diagnosis - 22/11/19
, Reginald E. Du, BS e, f, Claudia Pedroza, PhD c, Shuyan Wei, MD a, b, John A. Harvin, MD, MS, FACS a, b, Kevin W. Finkel, MD, FACP, FASN, FCCM d, Charles E. Wade, PhD a, f, Lillian S. Kao, MD, MS, FACS a, bAbstract |
Background |
Acute kidney injury (AKI) after trauma is associated with poor outcomes. According to current guidelines, a diagnosis of AKI should be made based on an increase in serum creatinine from a reference value. However, a true reference is often unknown in patients presenting with traumatic injury. The aim of this study was to determine the optimal reference creatinine estimate for post-traumatic AKI diagnosis and staging. The optimal reference estimate was defined by a high incidence, strong prognostic ability, and incrementality at each stage.
Study Design |
This was a cohort study of adult trauma patients (older than 16 years) requiring ICU admission between 2009 and 2018 (n = 8,026) at a single Level I trauma center. AKI was determined using the following 4 reference creatinine estimates: Modified Diet of Renal Diseases (MDRD), Trauma MDRD, admission creatinine, and the first-day creatinine nadir. Inclusivity was assessed by incidence of AKI diagnosed with different reference creatinine estimates; prognostic ability was assessed by multivariable modified Poisson regression; and incrementality was assessed by correlation of mortality risk by AKI stage.
Results |
There was a wide range of AKI incidence, from 21% when using admission creatinine to 76% using the Trauma MDRD. The MDRD reference creatinine estimate resulted in an AKI incidence of 41% and a diagnosis that was both prognostic of mortality and incremental with each AKI stage. All other reference estimates resulted in AKI diagnoses that were either not prognostic or not incremental.
Conclusions |
Reference creatinine estimate determines the clinical importance of AKI diagnoses. In this study, the MDRD reference resulted in optimal AKI diagnoses.
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Abbreviations and Acronyms : AKI, GFR, MDRD, TMDRD, KDIGO, TQIP
Plan
| CME questions for this article available at jacscme.facs.org |
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| Disclosure Information: Authors have nothing to disclose. Timothy J Eberlein, Editor-in-Chief, has nothing to disclose. |
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| Disclosures outside the scope of this work: Dr Wade receives grant money from Grifols and Masimo and holds stock options with Decisio Health. |
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| Support for this study: This work was supported by the William Stamps Farish Fund, the Howell Family Foundation, the James H “Red” Duke Professorship, and the National Institute of General Medical Sciences of the NIH (5T32GM008792). |
Vol 229 - N° 6
P. 580 - décembre 2019 Retour au numéro
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