The incidence of acute kidney injury in patients with traumatic brain injury

Abstract

There is limited information on the incidence of acute kidney injury (AKI) in patients with traumatic brain injury (TBI) although AKI may contribute to morbidity and mortality. We investigated the incidence of AKI in patients with moderate and severe TBI and the association of AKI with risk factors and outcomes in these patients. We studied all TBI patients over 16 years of age admitted to the two designated trauma hospitals in the state of Victoria, Australia from 1 January to 31 December 2008. Patients were included if they had head trauma and presented with a Glasgow coma scale (GCS) <13. Prospectively collected data from the hospital trauma registries, ICUs, and pathology databases were analyzed retrospectively. Risk injury failure loss end (RIFLE) criteria were used to categorize renal function. The incidence of AKI was 9.2% (19/207). Patients who developed AKI were older, had higher severity of illness scores, and a lower GCS. Overall 42.1% of these patients died in hospital compared with 18.1% in patients without AKI. In univariable linear regression analysis, age, severity of illness, and admitting hospital were associated with AKI. After multivariable logistic regression, the occurrence of AKI was associated with age (p < 0.001) and higher APACHE III scores (p = 0.016). AKI is relatively common even in patients with TBI. Its association with age and APACHE III scores helps identify patients at higher risk of AKI.

Association of AKI with Adverse Outcomes in Burned Military Casualties

“…One possible explanation is that TBI, which is common in combat casualties, is modulating the effect. In a recent study, the incidence of AKI in the setting of TBI was 9.2% and was associated with a mortality rate of 42.1% compared with 18.1% in patients without AKI (25). Although TBI was not associated with mortality in our population, the low incidence (8.8% in the cohort with $20% TBSA) makes a significant difference difficult to detect.…”

Acute Kidney Injury in Patients with Severe Traumatic Brain Injury: Implementation of the Acute Kidney Injury Network Stage System

“…The natural follow-up question is to address whether this new system of renal dysfunction stratification carries any medical significance. Recently, Zacharia reported an incidence of AKI in 23% of patients with aneurysmal SAH [17], and Moore reported an incidence of AKI in 9% of TBI patients with GCS less than 13 [18]. Importantly, these AKI patients had an increased risk of MOF and death.…”

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“…It should also be mentioned that AKI is relatively common in patients with traumatic brain injury (TBI), with an incidence of 9.2%. 35 Our study showed that prolonged donor stay in the ICU is associated with more severe damage of donor kidney, which affects the outcome of transplant.…”