Risk of severe acute kidney injury in multiple trauma patients: Risk estimation based on a national trauma dataset

Abstract

The development of acute kidney injury (AKI) in trauma patients has been associated with almost three fold increase in overall mortality. However, there is a paucity of information of early recognition of risk factors of severe AKI in trauma patients examining the patient's demography, injury characteristics and comorbidities. The purpose of the study was early identification of risk factors of severe AKI. This retrospective cohort study was performed using 2012-2016, American College of Surgeon Trauma Quality improvement program (ACS-TQIP) data, a national data base of trauma patients in the United State. All adult Trauma patients, age 16 to 89 years old, admitted to the hospital were included in the study. Other variables included; race, sex, initial systolic blood pressure (SBP), SBP<90 mmHg, heart rate, injury severity score (ISS), Glasgow Coma Scale Motor Score (GCSMOT), injury type and patient's comorbidities; diabetes mellitus (DM), hypertension (HTN), congestive heart failure (CHF) and history of smoking. A multiple logistic regression model was used to assess the chance of having severe AKI. The receiver-operating characteristics (ROC) curve was constructed, and the corresponding area-under-the curve (AUC) was calculated. All p values <0.05 was considered statistically significant. Out of 935,402 trauma victims, 9,281 (0.99%) patients developed severe AKI. There were significant differences found between the groups (severe AKI presence vs AKI absence), regarding median age [IQR] (61[43-75] vs. 53[32-71]; p<0.001), ISS (18[10-29] vs. 12[9-17]; p<0.001), DM (25.6% vs. 13.2%; p<0.001), HTN (48.6% vs. 33.3%; p<0.001), CHF (9.8% vs. 3.4%; p<0.001) and history of smoking (16.5% vs. 21.3%; p<0.001) on univariate analysis. A multivariable analysis showed all variables above had a significant association of the development of severe AKI except history of smoking. Older age, male gender, high ISS, SBP<90 mmHg, history of DM, HTN, CHF had a higher odds of development of severe AKI. The model showed a moderate strength with area under the curve (AUC) value was 0.750 and the 95% confidence intervals were [0.740, 0.759]. Current analysis showed certain patients demography, injury characteristics, along with comorbidities are associated with risk of severe AKI.