Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study

Abstract

BackgroundThe development of acute kidney injury (AKI) in trauma patients has been associated with an almost threefold increase in overall mortality. Many risk factors of mortality in severe AKI have been reported, but majority of the studies have been performed using a single-center data or have a small sample size. The purpose of this study was to identify the risk factors of mortality in severe AKI trauma patients.MethodsThe study was performed using 2012-2016 American College of Surgeon Trauma Quality Improvement Program data, a national database of trauma patients in the USA.All adult trauma patients aged 16 to 89 years old, admitted to the hospital and who developed a severe AKI were included in the study. A p value of <0.05 was considered statistically significant.ResultsOut of 9309 trauma patients who developed severe AKI, 2641 (28.08%) died. There were significant differences found in bivariate analysis between the groups who died and who survived after developing a severe AKI. Multivariable analysis showed male sex, older age, higher Injury Severity Score, lower Glasgow Coma Scale, presence of hypotension (systolic blood pressure<90 mm Hg) and coagulopathy were all significantly associated with in-hospital mortality. The area under the curve value was 0.706 and the 95% CI was 0.68 to 0.727.DiscussionCurrent analysis showed certain patients’ characteristics are associated with higher mortality in patients with severe AKI. Prompt identification and aggressive monitoring and management in high-risk patients may result in reduced mortality.Level of evidenceIV.Study typeObservational cohort study.

Minor injury turns into major problem in severe acute kidney injury: a propensity matched analysis

“…Further analysis of the data showed that advanced age, black race, male gender, higher ISS, and presence of hypotension were associated with sAKI, which is consistent with prior studies. 5 18 The majority of risk factors identified in the current analysis are not modifiable (age, gender, and race). However, hypotension conferred a threefold increase in sAKI risk.…”

“…Prior studies evaluated the risk of sAKI in trauma patients found to have a median ISS of >17 5 18. The patients with sAKI who died in these studies had an ISS of >25.…”

“…However, late death (after 24 hours of injury) is often related to organ failure or infection 3. Acute kidney injury (AKI) is one of the in-hospital organ failure complications that can result in higher mortality and morbidity 4 5…”

“…Severe injury, higher Injury Severity Sore (ISS), hemorrhagic shock, and male gender were found to be some of the risk factors of AKI 8–12. The mortality associated with AKI can range from 20% to 70% 4 5. Likewise, the severity of AKI in the context of trauma often correlates with the outcomes, with more severe acute kidney injury (sAKI) (usually higher stages, eg, failure criteria in RIFLE) associated with worse outcomes.…”

Outcome of Trauma in Elderly Patients With Pre-existing Chronic Kidney Disease

“…CKD alters homeostatic pathways and adversely affects the respiratory, cardiac, and central nervous system on a microvascular level. 2,3 Currently, comorbidities such as CKD are not accounted for in Injury Severity Scores (ISSs) methodology within the trauma population. 3 However, the contribution of this pre-existing comorbidity should not be overlooked when estimating morbidity and mortality outcomes within the trauma population.…”