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Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients.

Publication ,  Journal Article
Muñoz, B; Schobel, SA; Lisboa, FA; Khatri, V; Grey, SF; Dente, CJ; Kirk, AD; Buchman, T; Elster, EA
Published in: Surgery
October 2020

BACKGROUND: Post-traumatic acute kidney injury has occurred in every major military conflict since its initial description during World War II. To ensure the proper treatment of combat casualties, early detection is critical. This study therefore aimed to investigate combat-related post-traumatic acute kidney injury in recent military conflicts, used machine learning algorithms to identify clinical and biomarker variables associated with the development of post-traumatic acute kidney injury, and evaluated the effects of post-traumatic acute kidney injury on wound healing and nosocomial infection. METHODS: We conducted a retrospective clinical cohort review of 73 critically injured US military service members who sustained major combat-related extremity wounds and had collected injury characteristics, assayed serum and tissue biopsy samples for the expression of protein and messenger ribonucleic acid biomarkers. Bivariate analyses and random forest recursive feature elimination classification algorithms were used to identify associated injury characteristics and biomarker variables. RESULTS: The incidence of post-traumatic acute kidney injury was 20.5%. Of that, 86% recovered baseline renal function and only 2 (15%) of the acute kidney injury group required renal replacement therapy. Random forest recursive feature elimination algorithms were able to estimate post-traumatic acute kidney injury with the area under the curve of 0.93, sensitivity of 0.91, and specificity of 0.91. Post-traumatic acute kidney injury was associated with injury severity score, serum epidermal growth factor, and tissue activin A type receptor 1, matrix metallopeptidase 10, and X-C motif chemokine ligand 1 expression. Patients with post-traumatic acute kidney injury exhibited poor wound healing and increased incidence of nosocomial infections. CONCLUSION: The occurrence of acute kidney injury in combat casualties may be estimated using injury characteristics and serum and tissue biomarkers. External validations of these models are necessary to generalize for all trauma patients.

Duke Scholars

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Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

October 2020

Volume

168

Issue

4

Start / End Page

662 / 670

Location

United States

Related Subject Headings

  • Young Adult
  • Wound Healing
  • War-Related Injuries
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Military Personnel
  • Male
  • Machine Learning
  • Iraq War, 2003-2011
 

Citation

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Chicago
ICMJE
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Muñoz, B., Schobel, S. A., Lisboa, F. A., Khatri, V., Grey, S. F., Dente, C. J., … Elster, E. A. (2020). Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients. Surgery, 168(4), 662–670. https://doi.org/10.1016/j.surg.2020.04.064
Muñoz, Beau, Seth A. Schobel, Felipe A. Lisboa, Vivek Khatri, Scott F. Grey, Christopher J. Dente, Allan D. Kirk, Timothy Buchman, and Eric A. Elster. “Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients.Surgery 168, no. 4 (October 2020): 662–70. https://doi.org/10.1016/j.surg.2020.04.064.
Muñoz B, Schobel SA, Lisboa FA, Khatri V, Grey SF, Dente CJ, et al. Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients. Surgery. 2020 Oct;168(4):662–70.
Muñoz, Beau, et al. “Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients.Surgery, vol. 168, no. 4, Oct. 2020, pp. 662–70. Pubmed, doi:10.1016/j.surg.2020.04.064.
Muñoz B, Schobel SA, Lisboa FA, Khatri V, Grey SF, Dente CJ, Kirk AD, Buchman T, Elster EA. Clinical risk factors and inflammatory biomarkers of post-traumatic acute kidney injury in combat patients. Surgery. 2020 Oct;168(4):662–670.
Journal cover image

Published In

Surgery

DOI

EISSN

1532-7361

Publication Date

October 2020

Volume

168

Issue

4

Start / End Page

662 / 670

Location

United States

Related Subject Headings

  • Young Adult
  • Wound Healing
  • War-Related Injuries
  • Surgery
  • Risk Factors
  • Retrospective Studies
  • Military Personnel
  • Male
  • Machine Learning
  • Iraq War, 2003-2011