Traumatic Brain Injury and Acute Kidney Injury—Outcomes and Associated Risk Factors

Abstract

Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher’s exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01–1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79–13.1)), rhabdomyolysis (OR 2.94 (1.69–5.11)), trauma-associated coagulopathy (OR 1.67 (1.05–2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12–2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.

Association between Serum Magnesium Levels and Risk of Acute Kidney Injury in Patients with Traumatic Brain Injury: A Retrospective Cohort Study from the MIMIC-IV Database

“…The secondary complications such as AKI in patients with TBI portend a poor prognosis. Barea-Mendoza et al [6] found that the occurrence of AKI in patients with TBI was associated with increased mortality. Several studies have reported the correlation between serum magnesium and AKI risk in patients with other diseases, such as cardiac surgery patients [14], malignancy patients [12], and critically ill children [23].…”

“…Acute kidney injury (AKI) is common after brain injury, with an incidence of 10% in patients with TBI [5]. Several studies have reported that patients with TBI who develop AKI are associated with a longer length of stay and an increased risk of mortality [5][6][7].…”

Acute kidney injury in neurocritical care

“…Myoglobin-associated rhabdomyolysis and renal toxicity should be considered in patients with TBI. A recent multicenter registry study found rhabdomyolysis present in 3.8% of patients with TBI and independently associated with AKI occurrence [ 54 ]. Moreover, while rhabdomyolysis and elevated serum/urinary myoglobin correlate with AKI occurrence, they also correlate with trauma severity and other renal insults.…”

Chronic kidney disease as a predictive factor for poor prognosis in traumatic brain injury among older adults: a case-control study

“…A growing amount of attention is being given to brain-kidney interactions, and some studies have explored the association between TBI and kidney dysfunction, with the majority of the research focusing on the relationship between TBI and post-traumatic acute kidney injury (AKI) ( 7 , 8 ). Although the mechanisms are not fully understood, potential factors contributing to TBI-induced AKI include post-injury inflammation and the dysregulation of catecholamine release ( 9 ).…”