African American race, obesity, and blood product transfusion are risk factors for acute kidney injury in critically ill trauma patients

Abstract

Purpose Acute kidney injury (AKI) is a common source of morbidity after trauma. We sought to determine novel risk factors for AKI, by Acute Kidney Injury Network (AKIN) criteria, in critically ill trauma patients. Materials and Methods Prospective cohort study of 400 patients admitted to the ICU of a level one trauma center, followed for development of AKI over five days. Results AKI developed in 147/400 (36.8%) patients. In multivariable regression analysis, independent risk factors for AKI included African American race (OR 1.86; 95% CI 1.08,3.18; p=0.024), body mass index ≥30 (OR 4.72 versus normal BMI, 95% CI 2.59, 8.61, p<0.001), diabetes mellitus (OR 3.26; 95% CI 1.30,8.20; p=0.012), abdominal Abbreviated Injury Scale score ≥4 (OR 3.78; 95% CI 1.79,7.96; p<0.001), and unmatched packed red blood cells administered during resuscitation (OR 1.13 per unit; 95% CI 1.04,1.23; p=0.004). AKIN stages 1, 2, and 3 were associated with hospital mortality rates of 9.8%, 13.7%, and 30.4%, respectively, compared with 3.8% for those without AKI (p<0.001). Conclusions AKI in critically ill trauma patients is associated with substantial mortality. The findings of African American race, obesity, and blood product administration as independent risk factors for AKI deserve further study to elucidate underlying mechanisms.

The ABO Histo-Blood Group and AKI in Critically Ill Patients with Trauma or Sepsis

“…There are several potential explanations for this finding. African descent is an independent risk factor for AKI (29,45). It is possible that, in individuals of African descent, any protective effects of blood type O are overwhelmed by other mechanisms that increase their AKI risk.…”

“…Detailed inclusion and exclusion criteria have been previously described (29,30). Patients were included if they had an injury severity score .15 (31).…”

“…Comparisons of patient characteristics by AKI status are provided in Table 1. As we have reported previously, risk factors for AKI included African ancestry, increased body mass index, and transfusion of blood products (29). ABO blood type was available in all 497 (100%) patients with trauma.…”

Consequences of Transfusing Blood Components in Patients With Trauma: A Conceptual Model

“…Additionally, those who received PRBCs were roughly 3 times more likely to experience acute respiratory distress syndrome (OR, 2.5; 95% CI, 1.6-3.3) and almost twice as likely to die (OR, 1.7; 95% CI, 1.4-1.9). Other investigators found similar associations between transfusion of PRBCs and adverse clinical outcomes such as transfusion-related acute lung injury, 25 acute kidney injury, 26 and thromboembolic events. 27 However, many of these studies were retrospective and observational; thus, the outcomes may have been due to other factors.…”

The Effects of Obesity on Outcomes in Trauma Injury: Overview of the Current Literature

“…Shashaty et al published risk factors for the development of AKI included obesity, being of African-American descent, and blood products given. 17 Obese patients after trauma are at higher risk for deep venous thrombosis (DVT) and possible pulmonary embolism (PE), which could lead to an increase chance of mortality. Patients following trauma have shown to be at a hypercoagulable state.…”