#3590 Investigating AKI in ICU trauma patients: incidence, risk rofiles, and outcome implications

Field: Medicine (Health Sciences)

Abstract Background and Aims Acute kidney injury (AKI) is a critical complication in trauma patients admitted to intensive care units (ICUs), significantly increasing morbidity and mortality. This study aimed to determine the incidence of AKI, identify associated risk factors, and evaluate its clinical impact in trauma patients admitted to the ICU in the only tertiary Trauma Center ICU of our country. Method A prospective observational study was conducted over 9 months, involving 120 trauma patients admitted to a university-affiliated ICU. AKI was diagnosed and staged according to the kidney disease: improving global outcomes (KDIGO) criteria inclusion criteria were age ≥18 years, baseline glomerular filtration rate (GFR) &gt;90 mL/min (to exclude pre-existing chronic kidney disease), and survival beyond the first 3 days of ICU admission. Patients with direct renal trauma were excluded. Descriptive statistics characterized the patient cohort, and comparisons between AKI and non-AKI groups were conducted to assess differences in demographic, clinical, and laboratory variables. Multivariable logistic regression was used to identify potential risk factors, while correlations were analyzed between AKI and biochemical markers, antibiotic use, and nephrotoxic drugs. Results The cohort had a mean age of 54.5 years (±19.5 SD), with most patients being male (84.7%). Hypertension and obesity were observed in 34.5% of patients each, while diabetes mellitus and cardiovascular disease were present in 29.5% and 10.6%, respectively. Surgical interventions were performed in 13.9%, while critical care interventions included intubation (70.8%), inotropic drugs (19.4%), and nephrotoxic agents (9.7%). AKI occurred in 40.28% (60 patients) of patients, classified as KDIGO Stage I (23/60, 37.93 %), Stage II (25/60, 41.38 %), and Stage III (12/60, 20.69 %). Elevated white blood cell counts (&gt;15×10³) and mean arterial pressure (&gt;89 mmHg) within the first 24 hours were associated with an increased risk of AKI. Patients with AKI exhibited higher lactate levels (&gt;2.2) and lower bicarbonate levels (&lt;22 mmol/L) than those without AKI (P &lt; 0.05). ICU stays were significantly prolonged in patients with AKI, with a median survival time of 14 days for AKI Stage I–III compared to 79 days for non-AKI patients. Logistic regression indicated that nephrotoxic agent use (OR: 2.8, 95% CI: 1.1–7.1), lactate levels (OR: 3.2, 95% CI: 1.3–8.4), and bicarbonate levels (OR: 2.1, 95% CI: 1.1–5) were potential predictors of AKI, although the limited sample size reduced statistical significance (P &gt; 0.05). Combining a PLT/Albumin ratio at day 2 with a cutoff of 77.42 and lactate &gt; 2.2 mmol/L in the first 24 hours showed excellent predictive performance for AKI occurrence after day 3, with an AUC of 0.87, sensitivity of 90%, and specificity of 85.7%, highlighting their potential as early biomarkers for AKI in critically ill trauma patients. Additionally, vancomycin and nonsteroidal anti-inflammatory drug use showed positive correlations with AKI (P &lt; 0.05). Conclusion AKI was a common and severe complication in ICU trauma patients, with significant impacts on resource utilization and patient outcomes. Early identification of risk factors—such as elevated lactate levels, high white blood cell counts, and exposure to nephrotoxic medications—may enable timely interventions to mitigate AKI risk. Additionally, the PLT/Albumin ratio on day 2, combined with lactate levels &gt;2.2 mmol/L within the first 24 hours, demonstrates strong predictive potential for AKI occurrence beyond day 3, with excellent diagnostic accuracy. Larger cohort studies are needed to confirm these findings and improve predictive models for clinical management.