Acute kidney injury in traumatic brain injury intensive care unit patients

Zheng-Yang Huang; Yong Liu; Hao-Fan Huang; Shu-Hua Huang; Jing-Xin Wang; Jin-Fei Tian; Wen-Xian Zeng; Rong-Gui Lv; Song Jiang; Jun-Ling Gao; Yi Gao; Xia-Xia Yu

doi:10.12998/wjcc.v10.i9.2751

Acute kidney injury in traumatic brain injury intensive care unit patients

World J Clin Cases. 2022 Mar 26;10(9):2751-2763. doi: 10.12998/wjcc.v10.i9.2751.

Authors

Affiliations

¹ School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518037, Guangdong Province, China.
² Intensive Care Unit, Shenzhen Hospital, Southern Medical University, Shenzhen 518101, Guangdong Province, China.
³ Department of Medicine, LKS Medical Faculty, The University of Hong Kong, Hongkong 999077, China.
⁴ School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518037, Guangdong Province, China. xiaxiayu@szu.edu.cn.

Abstract

Background: The exact definition of Acute kidney injury (AKI) for patients with traumatic brain injury (TBI) is unknown.

Aim: To compare the power of the "Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease" (RIFLE), Acute Kidney Injury Network (AKIN), Creatinine kinetics (CK), and Kidney Disease Improving Global Outcomes (KDIGO) to determine AKI incidence/stage and their association with the in-hospital mortality rate of patients with TBI.

Methods: This retrospective study collected the data of patients admitted to the intensive care unit for neurotrauma from 2001 to 2012, and 1648 patients were included. The subjects in this study were assessed for the presence and stage of AKI using RIFLE, AKIN, CK, and KDIGO. In addition, the propensity score matching method was used.

Results: Among the 1648 patients, 291 (17.7%) had AKI, according to KDIGO. The highest incidence of AKI was found by KDIGO (17.7%), followed by AKIN (17.1%), RIFLE (12.7%), and CK (11.5%) (P = 0.97). Concordance between KDIGO and RIFLE/AKIN/CK was 99.3%/99.1%/99.3% for stage 0, 36.0%/91.5%/44.5% for stage 1, 35.9%/90.6%/11.3% for stage 2, and 47.4%/89.5%/36.8% for stage 3. The in-hospital mortality rates increased with the AKI stage in all four definitions. The severity of AKI by all definitions and stages was not associated with in-hospital mortality in the multivariable analyses (all P > 0.05).

Conclusion: Differences are seen in AKI diagnosis and in-hospital mortality among the four AKI definitions or stages. This study revealed that KDIGO is the best method to define AKI in patients with TBI.

Keywords: Acute Kidney Injury; Evaluation; In-hospital mortality; Kidney Disease Improving Global Outcomes; Traumatic brain injury.