Incidence and risk factors for acute kidney injury after traumatic hemorrhagic shock: A 10-year retrospective cohort study.

Abstract

Acute kidney injury (AKI) is a common complication of traumatic hemorrhagic shock. Therisk factors for AKI aftertraumatic hemorrhagic shockremain unclear. The aim of this study was to investigate the risk factors for AKI after traumatic hemorrhagic shock. This was a ten-year retrospective cohort study of patients who experiencedtraumatic hemorrhagic shock between January 2013 and April 2023. Patient characteristics and clinical data were recorded for 417 patients. The outcome was the occurrence of AKI, defined as a serum creatinine increase of ≥ 0.3mg/dL (≥ 26.5μmol/L) within 48h, or an increase to 1.5 times the baseline, or a urine volume of <0.5mL/(kg h.). Risk factors for AKI were tested by logistic regressionmodels. The incidence of AKI after traumatic hemorrhagic shockwas 29.3% (122/417 patients). Multivariable analysis revealed that the independent risk factors for AKIincluded age (OR, 1.048; 95% CI, 1.022-1.074; p < 0.001), B-type natriuretic peptide (OR, 1.002; 95% CI, 1.000-1.004; p = 0.041), sepsis (OR, 4.536; 95% CI, 1.651-12.462; p = 0.030) and acute myocardial injury (OR, 2.745; 95% CI, 1.027-7.342; p = 0.044). Road traffic accidents (OR, 0.202; 95% CI, 0.076-0.541; p = 0.001), mean arterial pressure (OR, 0.972; 95% CI, 0.950-0.995; p = 0.017), and base excess (OR, 0.842; 95% CI, 0.764-0.929; p = 0.001) were negatively correlated with AKI. The area under the receiver operating characteristic (ROC)curvefor prediction by thismodel was 0.85(95% CI, 0.81-0.90). The incidence of AKI aftertraumatic hemorrhagic shockwas 29.3%in our series. Indicators of bloodperfusion, sepsis and acute myocardial injury may be independent risk factors for AKI aftertraumatic hemorrhagic shock. Early detection and effective intervention on these risk factors could reduce the occurrence of AKI and improve outcomes.