PMID- 31733328
OWN - NLM
STAT- MEDLINE
DCOM- 20200924
LR  - 20210310
IS  - 1879-1190 (Electronic)
IS  - 1072-7515 (Print)
IS  - 1072-7515 (Linking)
VI  - 230
IP  - 2
DP  - 2020 Feb
TI  - Positive Fluid Balance and Association with Post-Traumatic Acute Kidney Injury.
PG  - 190-199.e1
LID - S1072-7515(19)32169-6 [pii]
LID - 10.1016/j.jamcollsurg.2019.10.009 [doi]
AB  - BACKGROUND: Acute kidney injury (AKI) is common in severely injured trauma 
      patients and is associated with poor outcomes. A positive fluid balance is 
      associated with AKI and poor long-term renal outcomes among general ICU and 
      cardiac surgery patients. Currently, the optimal endpoint of resuscitation of 
      severely injured trauma patients is unknown, which may result in excess fluid 
      administration. We hypothesized that positive fluid balance is common after 
      severe trauma and is associated with increased AKI development. STUDY DESIGN: A 
      cohort study of adult (>/=16 years old) trauma patients requiring ICU admission 
      from January 2017 to June of 2017 was conducted. Patients were excluded for early 
      death, rhabdomyolysis, or previous history of end-stage renal disease or 
      congestive heart failure. Acute kidney injury within 7 days of admission was 
      defined according to Kidney Disease Improving Global Outcomes creatinine-based 
      criteria. Univariate and multivariable analyses were performed. RESULTS: Of 364 
      patients, 74% were male. The median age was 41 years (interquartile range [IQR] 
      27 to 59 years), and the median Injury Severity Score (ISS) was 18 (IQR 10 to 
      29). Positive fluid balance (>2 L) was observed in 49% of patients. Acute kidney 
      injury was diagnosed in 105 (29%) patients. After adjustment, there was an 
      increased risk of AKI with a positive fluid balance >2 L (relative risk [RR] 1.98 
      [95% CI 1.24 to 3.17]). Additionally, the risk of AKI incrementally increased by 
      1.22 with each liter fluid positive above a zero balance (95% CI 1.11 to 1.34). 
      CONCLUSIONS: Positive fluid balance in excess of 2 L at 48 hours occurs in half 
      of severely injured trauma patients, and fluid positivity is independently and 
      incrementally associated with AKI development. Fluid responsiveness should be 
      investigated as an end point of post-traumatic resuscitation to prevent 
      unnecessary fluid administration and subsequent AKI.
CI  - Copyright (c) 2019 American College of Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Hatton, Gabrielle E
AU  - Hatton GE
AD  - Division of Acute Care Surgery, Department of Surgery, McGovern Medical School, 
      Houston, TX; Center for Surgical Trials and Evidence-based Practice, McGovern 
      Medical School, Houston, TX. Electronic address: Gabrielle.E.Hatton@uth.tmc.edu.
FAU - Du, Reginald E
AU  - Du RE
AD  - McGovern Medical School at UTHealth, McGovern Medical School, Houston, TX; Center 
      for Translational Injury Research, Houston, TX.
FAU - Wei, Shuyan
AU  - Wei S
AD  - Division of Acute Care Surgery, Department of Surgery, McGovern Medical School, 
      Houston, TX; Center for Surgical Trials and Evidence-based Practice, McGovern 
      Medical School, Houston, TX.
FAU - Harvin, John A
AU  - Harvin JA
AD  - Division of Acute Care Surgery, Department of Surgery, McGovern Medical School, 
      Houston, TX; Center for Surgical Trials and Evidence-based Practice, McGovern 
      Medical School, Houston, TX.
FAU - Finkel, Kevin W
AU  - Finkel KW
AD  - Division of Acute Care Surgery, Department of Surgery, McGovern Medical School, 
      Houston, TX; Division of Renal Diseases and Hypertension, Department of Medicine, 
      McGovern Medical School, Houston, TX.
FAU - Wade, Charles E
AU  - Wade CE
AD  - Division of Acute Care Surgery, Department of Surgery, McGovern Medical School, 
      Houston, TX; Center for Translational Injury Research, Houston, TX.
FAU - Kao, Lillian S
AU  - Kao LS
AD  - Division of Acute Care Surgery, Department of Surgery, McGovern Medical School, 
      Houston, TX; Center for Surgical Trials and Evidence-based Practice, McGovern 
      Medical School, Houston, TX.
LA  - eng
GR  - T32 GM008792/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20191114
PL  - United States
TA  - J Am Coll Surg
JT  - Journal of the American College of Surgeons
JID - 9431305
SB  - IM
CIN - J Am Coll Surg. 2020 May;230(5):836-837. PMID: 32173250
CIN - J Am Coll Surg. 2020 May;230(5):837-838. PMID: 32234280
CIN - J Am Coll Surg. 2020 Jul;231(1):190-191. PMID: 32371034
CIN - J Am Coll Surg. 2020 Jul;231(1):191. PMID: 32414685
MH  - Acute Kidney Injury/epidemiology/*etiology/*physiopathology
MH  - Adult
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Injury Severity Score
MH  - Male
MH  - Middle Aged
MH  - *Water-Electrolyte Balance
MH  - Wounds and Injuries/*complications
PMC - PMC7220831
MID - NIHMS1543863
EDAT- 2019/11/17 06:00
MHDA- 2020/09/25 06:00
PMCR- 2021/02/01
CRDT- 2019/11/17 06:00
PHST- 2019/09/09 00:00 [received]
PHST- 2019/10/13 00:00 [revised]
PHST- 2019/10/21 00:00 [accepted]
PHST- 2019/11/17 06:00 [pubmed]
PHST- 2020/09/25 06:00 [medline]
PHST- 2019/11/17 06:00 [entrez]
PHST- 2021/02/01 00:00 [pmc-release]
AID - S1072-7515(19)32169-6 [pii]
AID - 10.1016/j.jamcollsurg.2019.10.009 [doi]
PST - ppublish
SO  - J Am Coll Surg. 2020 Feb;230(2):190-199.e1. doi: 
      10.1016/j.jamcollsurg.2019.10.009. Epub 2019 Nov 14.