Erythropoietin in traumatic brain injury associated acute kidney injury: A randomized controlled trial

Clinical Laboratory Analysis

et al. 2020

Background Red blood cell distribution width (RDW) has been validated valuable in predicting outcome and acute kidney injury (AKI) in several clinical settings. The aim of this study was to explore whether RDW is associated with outcome and AKI in patients with traumatic brain injury (TBI). Methods Patients admitted to our hospital for TBI from January 2015 to August 2018 were included in this study. Multivariate logistic regression analysis was performed to identify risk factors of AKI and outcome in patients with TBI. The value of RDW in predicting AKI and outcome was evaluated by receiver operating characteristic (ROC) curve. Results Three hundred and eighteen patients were included in this study. The median of RDW was 14.25%. We divided subjects into two groups based on the median and compared difference of variables between two groups. The incidence of AKI and mortality was higher in high RDW (RDW > 14.25) group (31.45% vs 9.43%, P < .001; 69.81% vs 29.56%, P < .001). Spearman's method showed RDW was moderately associated with 90‐day Glasgow Outcome Scale (GOS) (P < .001). In multivariate logistic regression analysis, RDW, lymphocyte, chlorine, and serum creatinine were risk factors of AKI. And Glasgow Coma Scale (GCS), glucose, chlorine, AKI, and RDW were risk factors of mortality. The area under the ROC curve (AUC) of RDW for predicting AKI and mortality was 0.724 (0.662‐0.786) and 0.754 (0.701‐0.807), respectively. Patients with higher RDW were likely to have shorter median survival time (58 vs 70, P < .001). Conclusions Red blood cell distribution width is an independent risk factor of AKI and mortality in patients with TBI.

Section: Discussionmentioning

confidence: 44%

“…Acute kidney injury following TBI has been paid much attention for the harmful effects it brings to the outcome. Several studies have investigated the incidence of AKI following TBI, ranged from 3.5% to 40% 5‐7,19,20 . The incidence of AKI was 20.44% in our study.…”

Section: Discussionmentioning

confidence: 64%

The predictive value of RDW in AKI and mortality in patients with traumatic brain injury

Clinical Laboratory Analysis

et al. 2020

“…The single cystatin C level was effective in predicting AKI while combining four factors above mentioned was more accurate than cystatin C alone in evaluating the possible occurrence of AKI in TBI patients. The development of AKI is a prevalent non-neurologic complication in TBI patients, which has been reported occurring in 7.6% to 23% TBI patients [4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Acute kidney injury (AKI) is one form of these systemic complications manifested as rapid occurrence of renal dysfunction. AKI after TBI has been reported developing in 7.6% to 23% patients and is correlated with mortality, functional outcome and length of hospital stay in TBI patients [4][5][6][7]. Mechanisms involved in development of AKI after TBI are diversified, which included systemic inflammation response, neuroendocrine hormone release, hypoperfusion and iatrogenic factors such as blood transfusion, drugs reducing intracranial pressure and usage of nephrotoxic antibiotics [8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

A nomogram based on serum cystatin C for predicting acute kidney injury in patients with traumatic brain injury

Gui

et al. 2021

Renal Failure

Background Acute kidney injury (AKI) is a common complication in traumatic brain injury (TBI) patients and is associated with unfavorable outcome of these patients. We designed this study to explore the value of serum cystatin C, an indicator of renal function, on predicting AKI after suffering TBI. Methods Patients confirmed with TBI and hospitalized in the West China Hospital of Sichuan University between January 2015 and December 2019 were included. Patients were divided into two groups according to occurrence of AKI. Univariate and multivariate logistic regression analyses were sequentially utilized to find risk factors of AKI in included TBI patients. Nomogram composed of discovered risk factors for predicting AKI was constructed. Receiver operating characteristics (ROC) curves were drawn and area under the ROC curve (AUC) were calculated to evaluate the predictive value of cystatin C alone and the constructed nomogram. Results Among 234 included TBI patients, 55 were divided into AKI group. AKI group had shorter length of stay ( p < 0.001) and higher in-hospital mortality ( p < 0.001). Multivariate logistic regression analysis showed absolute lymphocyte count ( p = 0.034), serum creatinine ( p < 0.001), serum cystatin C ( p = 0.017) and transfusion of red blood cell ( p = 0.005) were independently associated with development of AKI after TBI. While hypertonic saline use was not associated with the development of AKI ( p = 0.067). The AUC of single cystatin C and predictive nomogram were 0.804 and 0.925, respectively. Conclusion Higher serum cystatin C is associated with development of AKI in TBI patients. Predictive nomogram incorporating cystatin C is beneficial for physicians to evaluate possibilities of AKI and consequently adjust treatment strategies to avoid occurrence of AKI.

“…In our study, the percentage of patients developing AKI was 21.12% according to the KIDGO criteria. Previous studies reported that the incidence of AKI following TBI ranged from 0.45% to 35% [ 3 , 19 – 21 ]. This variability might originate from different diagnostic criteria for AKI, severity of the included patients, and different medical level.…”

Section: Discussionmentioning

confidence: 99%

The Predictive Value of Serum Uric Acid on Acute Kidney Injury following Traumatic Brain Injury

BioMed Research International

et al. 2020

Backgrounds. Acute kidney injury (AKI) is a prevalent nonneurological complication in patients with traumatic brain injury (TBI). We designed this study to explore the association between serum uric acid (SUA) level and the occurrence of AKI following TBI. Methods. This is a retrospective single-center study. A total of 479 patients admitted with TBI were included in this study. We utilized SUA and other risk factors for AKI to construct a predictive model by performing multivariate logistic regression. 374 patients and 105 patients were, respectively, divided into a training set and validation set. The predictive value of the single SUA and constructed model was evaluated by drawing a receiver operating characteristic (ROC) curve. AKI was diagnosed according to the KIDGO criteria. Results. 79 (21.12%) patients were diagnosed with AKI in the training cohort. The patients in the AKI group are older than those in the non-AKI group (p=0.01). And the Glasgow Coma Scale (GCS) of the AKI group was lower than that of the non-AKI group (p<0.001). In a multivariate logistic regression analysis, we found that heart rate (p=0.041), shock (p=0.018), serum creatinine (p<0.001), and serum uric acid (SUA) (p<0.001) were significant risk factors for AKI. Bivariate correlation analyses showed that serum creatinine was moderately positively correlated with SUA (r=0.523, p<0.001). Finally, the area under the receiver operating characteristic curve (AUC) of SUA for predicting AKI in the training set and validation set was 0.850 (0.805-0.895) and 0.869 (0.801-0.938), respectively. Conclusions. SUA is an effective risk factor for AKI following TBI. Combining SUA with serum creatinine could more accurately identify TBI patients with high risk of developing AKI.