One-Year Mortality Associations in Hemodialysis Patients after Traumatic Brain Injury—An Eight-Year Population-Based Study

Jen-Chieh Liao,Chung-Han Ho,Jinn-Rung Kuo,Chung-Ching Chio,Kao-Chang Lin,Jhi-Joung Wang,Fu-Wen Liang,Daqing Ma

doi:10.1371/journal.pone.0093956

Abstract

PurposeThis study aimed to investigate the one-year mortality associations in hemodialysis patients who underwent neurosurgical intervention after traumatic brain injury (TBI) using a nationwide database in Taiwan.Materials and MethodsAn age- and gender-matched longitudinal cohort study of 4416 subjects, 1104 TBI patients with end-stage renal disease (ESRD) and 3312 TBI patients without ESRD, was conducted using the National Health Insurance Research Database in Taiwan between January 2000 and December 2007. The demographic characteristics, length of stay (LOS), length of ICU stay, length of ventilation (LOV), and tracheostomy were collected and analyzed. The co-morbidities of hypertension (HTN), diabetes mellitus (DM), myocardial infarction (MI), stroke, and heart failure (HF) were also evaluated.ResultsTBI patients with ESRD presented a shorter LOS, a longer length of ICU stay and LOV, and a higher percentage of comorbidities compared with those without ESRD. TBI patients with ESRD displayed a stable trend of one-year mortality rate, 75.82% to 76.79%, from 2000–2007. For TBI patients with ESRD, the median survival time was 0.86 months, and pre-existing stroke was a significant risk factor of mortality (HR: 1.29, 95% C.I.: 1.08–1.55). Pre-existing DM (HR: 1.35, 95% C.I.: 1.12–1.63) and MI (HR: 1.61, 95% C.I.: 1.07–2.42) effect on the mortality in ESRD patients who underwent TBI surgical intervention in the younger (age<65) and older (age≥65) population, respectively. In addition, the length of ICU stay and tracheostomy may provide important information to predict the mortality risk.ConclusionsThis is the first report indicating an increased risk of one-year mortality among TBI patients with a pre-existing ERSD insult. Comorbidities were more common in TBI patients with ESRD. Physicians should pay more attention to TBI patients with ESRD based on the status of age, comorbidities, length of ICU stay, and tracheostomy to improve their survival.

Highlights

The population of patients with end-stage renal disease (ESRD) requiring dialysis is progressively growing, and the mortality rate of this group is much higher than that of the general population in the USA in recent decades[1]
For traumatic brain injury (TBI) patients with ESRD, the median survival time was 0.86 months, and preexisting stroke was a significant risk factor of mortality (HR: 1.29, 95% C.I.: 1.08–1.55)
Pre-existing diabetes mellitus (DM) (HR: 1.35, 95% C.I.: 1.12–1.63) and myocardial infarction (MI) (HR: 1.61, 95% C.I.: 1.07–2.42) effect on the mortality in ESRD patients who underwent TBI surgical intervention in the younger and older population, respectively

Summary

Introduction

The population of patients with end-stage renal disease (ESRD) requiring dialysis is progressively growing, and the mortality rate of this group is much higher than that of the general population in the USA in recent decades[1]. In Taiwan, cases of ESRD requiring hemodialysis have increased considerably over the past few decades [2,3]. The data indicate that ESRD patients have a greater number of comorbidities, such as diabetes, stroke, hypertension, and heart disease, than non-ESRD patients admitted to the ICU [10]. These comorbidities are often one of the risk factors for mortality [11]

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