Association Between Succinylated Gelatin Exposure and Acute Kidney Injury in Critically Ill Trauma Patients: A Retrospective Five-Year Cohort Study
4 affiliations
- 1Department of Anaesthesia and Intensive Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria
- 2Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
- 3Institute for Sports Medicine, Alpine Medicine and Health Tourism, UMIT–University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria
- 4Data Lab Hell, Non-University Research Institution, 6170 Zirl, Austria
Abstract
Background/Objectives: Early fluid resuscitation is a cornerstone of trauma care, but the relationship between resuscitation strategies and acute kidney injury (AKI) remains insufficiently characterized. This study aimed to evaluate whether administration of 4% succinylated gelatin is associated with the development of AKI in critically ill trauma patients during the first seven days of intensive care unit (ICU) treatment. Methods: We conducted an observational retrospective single-center cohort study including 215 adult trauma patients admitted to the ICU at a tertiary care center between 2015 and 2020. Gelatin exposure, kidney function, and clinical outcomes were assessed from the pre-ICU phase through the first ICU week. The primary outcome was the development of AKI, at stage ≥ 2 of the Kidney Disease: Improving Global Outcomes (KDIGO) staging. We used mixed-effects models, competing-risk analyses, correlation analyses and exploratory unsupervised clustering to explore associations between gelatin use and renal outcomes. Results: AKI occurred in 17% of patients and was associated with older age, higher Simplified Acute Physiology Score 3 (SAPS3), pre-existing comorbidities, and early signs of hemodynamic and metabolic compromise. Gelatin doses of ≥10 mL/kg/day were not associated with a consistent rise in serum creatinine or progression of AKI over time. Multivariable regression models revealed no independent association between gelatin and worsening AKI. Instead, KDIGO stage worsening was primarily associated with AKI present at ICU admission and with crystalloid volume. Clustering analysis identified a high-risk phenotype with increased gelatin exposure, but this cluster also showed pronounced shock and inflammation, suggesting confounding by indication. In a competing-risk analysis, gelatin was not associated with new-onset AKI, whereas higher gelatin doses were associated with a lower rate of ICU discharge. Conclusions: In this retrospective cohort of critically ill trauma patients, succinylated gelatin administration showed no statistically significant association with KDIGO-defined AKI progression across unadjusted and adjusted models. Gelatin doses of ≥10 mL/kg/day were more frequently administered in patients with greater hemodynamic instability, suggesting that gelatin use primarily reflected underlying illness severity rather than acting as a direct nephrotoxic agent. These findings provide no evidence of an independent nephrotoxic effect of gelatin when used as part of balanced trauma resuscitation strategies.
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BibTeX
@article{treichl2026association,
title = {{Association Between Succinylated Gelatin Exposure and Acute Kidney Injury in Critically Ill Trauma Patients: A Retrospective Five-Year Cohort Study}},
author = {Benjamin Treichl and Mirjam Bachler and Jennifer Gebetsberger and Philipp Martin Lichtenberger and Pia Tscholl and Johannes Bösch and Daniel Niederbrunner and Daniel Stürzel and Michael Rauscher and Dietmar Fries},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218598},
url = {https://www.mdpi.com/2077-0383/15/21/8598},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association Between Succinylated Gelatin Exposure and Acute Kidney Injury in Critically Ill Trauma Patients: A Retrospective Five-Year Cohort Study
AU - Benjamin Treichl
AU - Mirjam Bachler
AU - Jennifer Gebetsberger
AU - Philipp Martin Lichtenberger
AU - Pia Tscholl
AU - Johannes Bösch
AU - Daniel Niederbrunner
AU - Daniel Stürzel
AU - Michael Rauscher
AU - Dietmar Fries
PY - 2026
DA - 2026/11/04
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218598
UR - https://www.mdpi.com/2077-0383/15/21/8598
AB - Background/Objectives: Early fluid resuscitation is a cornerstone of trauma care, but the relationship between resuscitation strategies and acute kidney injury (AKI) remains insufficiently characterized. This study aimed to evaluate whether administration of 4% succinylated gelatin is associated with the development of AKI in critically ill trauma patients during the first seven days of intensive care unit (ICU) treatment. Methods: We conducted an observational retrospective single-center cohort study including 215 adult trauma patients admitted to the ICU at a tertiary care center between 2015 and 2020. Gelatin exposure, kidney function, and clinical outcomes were assessed from the pre-ICU phase through the first ICU week. The primary outcome was the development of AKI, at stage ≥ 2 of the Kidney Disease: Improving Global Outcomes (KDIGO) staging. We used mixed-effects models, competing-risk analyses, correlation analyses and exploratory unsupervised clustering to explore associations between gelatin use and renal outcomes. Results: AKI occurred in 17% of patients and was associated with older age, higher Simplified Acute Physiology Score 3 (SAPS3), pre-existing comorbidities, and early signs of hemodynamic and metabolic compromise. Gelatin doses of ≥10 mL/kg/day were not associated with a consistent rise in serum creatinine or progression of AKI over time. Multivariable regression models revealed no independent association between gelatin and worsening AKI. Instead, KDIGO stage worsening was primarily associated with AKI present at ICU admission and with crystalloid volume. Clustering analysis identified a high-risk phenotype with increased gelatin exposure, but this cluster also showed pronounced shock and inflammation, suggesting confounding by indication. In a competing-risk analysis, gelatin was not associated with new-onset AKI, whereas higher gelatin doses were associated with a lower rate of ICU discharge. Conclusions: In this retrospective cohort of critically ill trauma patients, succinylated gelatin administration showed no statistically significant association with KDIGO-defined AKI progression across unadjusted and adjusted models. Gelatin doses of ≥10 mL/kg/day were more frequently administered in patients with greater hemodynamic instability, suggesting that gelatin use primarily reflected underlying illness severity rather than acting as a direct nephrotoxic agent. These findings provide no evidence of an independent nephrotoxic effect of gelatin when used as part of balanced trauma resuscitation strategies.
SN - 2077-0383
ER -