TY - JOUR
T1 - Risk Factors and Clinical Outcomes Associated With Augmented Renal Clearance in Trauma Patients
AU - Mulder, Michelle B.
AU - Eidelson, Sarah A.
AU - Sussman, Matthew S.
AU - Schulman, Carl I.
AU - Lineen, Edward B.
AU - Iyenger, Rahul S.
AU - Namias, Nicholas
AU - Proctor, Kenneth G.
N1 - Funding Information:
The authors would like to acknowledge the support and assistance of our research coordinator, Ronald Manning, RN, BSN, MSPH, who assisted with patient enrollment, data collection, and compliance. In addition, Madeline A. Cohen, MSPH, BS, Gabriel A. Lama, BS, Amy Valdin, RN, and SriGita Madiraju, BS, assisted with data collection. Authors? contributions: M.B.M. had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis. M.B.M. S.A.E. C.I.S. N.N. and K.G.P. contributed to study concept and design; M.B.M. S.A.E. M.S.S. R.S.I. C.I.S. E.B.L. and N.N. contributed to acquisition, analysis, or interpretation of data; M.B.M. S.A.E. R.S.I. and K.G.P. drafting of the article. All authors made critical revision of the article for important intellectual content. M.B.M. contributed to statistical analysis. C.I.S. and N.N. contributed to administrative, technical, or material support. K.G.P. supervised to study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/12
Y1 - 2019/12
N2 - Background: Augmented renal clearance (ARC; i.e., creatinine clearance [CLCr] ≥ 130 mL/min) has an incidence of 14%-80% in critically ill patients and has been associated with therapy failures for renally cleared drugs. However, the clinical implications of ARC are poorly defined. We hypothesize that modifiable risk factors that contribute to ARC can be identified in severely injured trauma patients and that these risk factors influence clinical outcome. Methods: In 207 trauma intensive care unit patients, 24-h CLCr was correlated with clinical estimates of glomerular filtration rate (by Cockroft-Gault, modification of diet in renal disease, or chronic kidney disease epidemiology), and clinical outcomes (infection, venous thromboembolism [VTE], length of stay, and mortality). Results: The population was 45 ± 20 y, 68% male, 77% blunt injury with injury severity score of 24 (17-30). Admission serum creatinine was 1.02 ± 0.35 mg/dL, CLCr was 154 ± 77 mL/min, VTE incidence was 15%, ARC incidence was 57%, and mortality was 11%. Clinical estimates of glomerular filtration rate by Cockroft-Gault, modification of diet in renal disease, chronic kidney disease epidemiology underestimated actual CLCr by 20%, 22%, or 15% (all P < 0.01). CLCr was higher in males and those who survived, and lower in those with hypertension, diabetes, positive cultures, receiving transfusions, or pressors (all P < 0.05). On multivariate analysis, male gender (odds ratio [OR] 2.9 [1.4-6.1]), age (OR 0.97 [0.95-0.99]), and packed red blood cells transfusion (OR 0.31 [0.15-0.66]) were the only independent predictors of ARC. Conclusions: ARC occurs in more than half of all high-risk trauma intensive care unit patients and is underestimated by standard clinical equations. ARC was not associated with increased incidence of VTE or infection but rather is associated with younger healthier males and reduced mortality. ARC seems to be a beneficial compensatory response to trauma.
AB - Background: Augmented renal clearance (ARC; i.e., creatinine clearance [CLCr] ≥ 130 mL/min) has an incidence of 14%-80% in critically ill patients and has been associated with therapy failures for renally cleared drugs. However, the clinical implications of ARC are poorly defined. We hypothesize that modifiable risk factors that contribute to ARC can be identified in severely injured trauma patients and that these risk factors influence clinical outcome. Methods: In 207 trauma intensive care unit patients, 24-h CLCr was correlated with clinical estimates of glomerular filtration rate (by Cockroft-Gault, modification of diet in renal disease, or chronic kidney disease epidemiology), and clinical outcomes (infection, venous thromboembolism [VTE], length of stay, and mortality). Results: The population was 45 ± 20 y, 68% male, 77% blunt injury with injury severity score of 24 (17-30). Admission serum creatinine was 1.02 ± 0.35 mg/dL, CLCr was 154 ± 77 mL/min, VTE incidence was 15%, ARC incidence was 57%, and mortality was 11%. Clinical estimates of glomerular filtration rate by Cockroft-Gault, modification of diet in renal disease, chronic kidney disease epidemiology underestimated actual CLCr by 20%, 22%, or 15% (all P < 0.01). CLCr was higher in males and those who survived, and lower in those with hypertension, diabetes, positive cultures, receiving transfusions, or pressors (all P < 0.05). On multivariate analysis, male gender (odds ratio [OR] 2.9 [1.4-6.1]), age (OR 0.97 [0.95-0.99]), and packed red blood cells transfusion (OR 0.31 [0.15-0.66]) were the only independent predictors of ARC. Conclusions: ARC occurs in more than half of all high-risk trauma intensive care unit patients and is underestimated by standard clinical equations. ARC was not associated with increased incidence of VTE or infection but rather is associated with younger healthier males and reduced mortality. ARC seems to be a beneficial compensatory response to trauma.
KW - ARC
KW - GFR
KW - Outcomes
KW - Renal clearance
KW - Trauma
KW - VTE
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U2 - 10.1016/j.jss.2019.06.087
DO - 10.1016/j.jss.2019.06.087
M3 - Article
C2 - 31330291
AN - SCOPUS:85069571825
VL - 244
SP - 477
EP - 483
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
ER -
