Acute Kidney Injury in Critically Injured Combat Veterans: A Retrospective Cohort Study.

Acute kidney injury (AKI) has been associated with mortality after traumatic injury. However, there is a paucity of data for military service members with injuries received in combat. We sought to identify risk factors for AKI after combat trauma and evaluate whether AKI is a predictor of mortality. Retrospective observational study. US service members who were critically wounded in Iraq or Afghanistan from February 1, 2002, to February 1, 2011, and survived until evacuation to Landstuhl Regional Medical Center, Germany. Demographic variables, vital signs, injury severity score, presence of burn injury, and mechanism of injury as defined at the time of initial injury, as well as the presence of AKI ascertained within the first 7 days using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine criteria. Logistic regression models were used to identify risk factors for both AKI and death. Of 6,011 records, 3,807 were included for analysis after excluding patients with missing data. AKI occurred in 474 (12.5%) patients and 112 (2.9%) died. More patients with versus without AKI died (n=62 [13.1%] vs n=50 [1.5%]; P<0.001). After adjustment, AKI was a predictor of mortality (OR, 5.14; 95% CI, 3.33-7.93; P<0.001). Predictors of AKI were age, African American race, injury severity score, amputations, burns, and presenting vital signs. AKI diagnoses limited to creatinine-based definitions. AKI predicted mortality in combat veterans injured in the wars in Iraq and Afghanistan.

Stewart IJ ，Sosnov JA ，Howard JT ，Chung KK ... -  《-》

Rhabdomyolysis among critically ill combat casualties: Associations with acute kidney injury and mortality.

Stewart IJ ，Faulk TI ，Sosnov JA ，Clemens MS ，Elterman J ，Ross JD ，Howard JT ，Fang R ，Zonies DH ，Chung KK ... -  《-》

Early acute kidney injury in military casualties.

Heegard KD ，Stewart IJ ，Cap AP ，Sosnov JA ，Kwan HK ，Glass KR ，Morrow BD ，Latack W ，Henderson AT ，Saenz KK ，Siew ED ，Ikizler TA ，Chung KK ... -  《-》

Association of AKI with adverse outcomes in burned military casualties.

Stewart IJ ，Tilley MA ，Cotant CL ，Aden JK ，Gisler C ，Kwan HK ，McCorcle J ，Renz EM ，Chung KK ... -  《-》

Hyperkalemia in Combat Casualties: Implications for Delayed Evacuation.

Fixed facilities and rapid global evacuation ensured that delayed complications of trauma, such as hyperkalemia, occurred late in the evacuation chain where renal replacement therapies were available. However, future conflicts or humanitarian disasters may involve prolonged evacuation times. We sought to quantify one potential risk of delayed evacuation by assessing hyperkalemia in combat casualties. Retrospective study of military members admitted to intensive care units in Iraq and Afghanistan from February 1, 2002, to February 1, 2011. This study was approved by the U.S. Army Medical Research and Materiel Command Institutional Review Board. Demographics, injury severity score, burn injury, mechanism of injury, vital signs, creatinine, and potassium were collected. Logistic regression models were used to identify incidence and risk factors for hyperkalemia. Of 6,011 patient records, 1,472 had sufficient data to be included for analysis. Hyperkalemia occurred in 5.8% of patients. Those with hyperkalemia had higher injury severity scores, higher shock index, were more likely to have acute kidney injury, and were more likely to die. On multivariate analysis, acute kidney injury and shock index were significantly associated with the development of hyperkalemia. In a subgroup of patients with data on creatine kinase, rhabdomyolysis was associated with hyperkalemia in the univariate model, but was not significant after adjustment. Hyperkalemia occurred in 5.8% of patients in our cohort of critically injured combat casualties. The development of hyperkalemia was independently associated with acute kidney injury and shock index. In future conflicts, with prolonged evacuation times, mitigation strategies should be developed to treat hyperkalemia in casualties before arrival at definitive care.

Stewart IJ ，Snow BD ，Clemens MS ，Sosnov JA ，Ross JD ，Howard JT ，Chung KK ... -  《-》