. 2021 Oct;35(2):434-440.

doi: 10.1007/s12028-020-01183-z. Epub 2021 Jan 13.

Association of Severe Acute Kidney Injury with Mortality and Healthcare Utilization Following Isolated Traumatic Brain Injury

David Luu^{1

2}, Jordan Komisarow^{3

2}, Brianna M Mills^{4

5}, Monica S Vavilala^{4

6}, Daniel T Laskowitz⁷, Joseph Mathew¹, Michael L James^{1

7

2}, Adrian Hernandez^{8

9}, John Sampson³, Matt Fuller^{1

2}, Tetsu Ohnuma^{1

2}, Karthik Raghunathan^{1

2

9}, Jamie Privratsky^{1

2}, Raquel Bartz^{1

2}, Vijay Krishnamoorthy^{10

11

12}

Affiliations

¹ Duke University Medical Center, Department of Anesthesiology, DUMC 3094, Duke University, Durham, NC, 27710, USA.
² Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, USA.
³ Department of Neurosurgery, Duke University, Durham, USA.
⁴ Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA.
⁵ Department of Epidemiology, University of Washington, Seattle, USA.
⁶ Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA.
⁷ Departments of Neurology, Duke University, Durham, USA.
⁸ Departments of Medicine, Duke University, Durham, USA.
⁹ Population Health Sciences, Duke University, Durham, USA.
¹⁰ Duke University Medical Center, Department of Anesthesiology, DUMC 3094, Duke University, Durham, NC, 27710, USA. vijay.krishnamoorthy@duke.edu.
¹¹ Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, USA. vijay.krishnamoorthy@duke.edu.
¹² Population Health Sciences, Duke University, Durham, USA. vijay.krishnamoorthy@duke.edu.

PMID: 33442812
PMCID: PMC8275693
DOI: 10.1007/s12028-020-01183-z

Association of Severe Acute Kidney Injury with Mortality and Healthcare Utilization Following Isolated Traumatic Brain Injury

David Luu et al. Neurocrit Care. 2021 Oct.

. 2021 Oct;35(2):434-440.

doi: 10.1007/s12028-020-01183-z. Epub 2021 Jan 13.

Authors

Affiliations

¹ Duke University Medical Center, Department of Anesthesiology, DUMC 3094, Duke University, Durham, NC, 27710, USA.
² Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, USA.
³ Department of Neurosurgery, Duke University, Durham, USA.
⁴ Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA.
⁵ Department of Epidemiology, University of Washington, Seattle, USA.
⁶ Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA.
⁷ Departments of Neurology, Duke University, Durham, USA.
⁸ Departments of Medicine, Duke University, Durham, USA.
⁹ Population Health Sciences, Duke University, Durham, USA.
¹⁰ Duke University Medical Center, Department of Anesthesiology, DUMC 3094, Duke University, Durham, NC, 27710, USA. vijay.krishnamoorthy@duke.edu.
¹¹ Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, USA. vijay.krishnamoorthy@duke.edu.
¹² Population Health Sciences, Duke University, Durham, USA. vijay.krishnamoorthy@duke.edu.

PMID: 33442812
PMCID: PMC8275693
DOI: 10.1007/s12028-020-01183-z

Abstract

Background/objective: Traumatic brain injury (TBI) is a leading cause of morbidity, mortality, and disability in the USA. While cardiopulmonary dysfunction can result in poor outcomes following severe TBI, the impact of acute kidney injury (AKI) is poorly understood. We examined the association of severe AKI with hospital mortality and healthcare utilization following isolate severe TBI.

Methods: We conducted a retrospective cohort study using the National Trauma Data Bank from 2007 to 2014. We identified a cohort of adult patients with isolated severe TBI and described the incidence of severe AKI, corresponding to Acute Kidney Injury Network stage 3 disease or greater. We examined the association of severe AKI with the primary outcome of hospital mortality using multivariable logistic regression models. In secondary analyses, we examined the association of severe AKI with dialysis catheter placement, tracheostomy and gastrostomy utilization, and hospital length of stay.

Results: There were 37,851 patients who experienced isolated severe TBI during the study period. Among these patients, 787 (2.1%) experienced severe (Stage 3 or greater) AKI. In multivariable models, the development of severe AKI in the hospital was associated with in-hospital mortality (OR 2.03, 95% CI 1.64-2.52), need for tracheostomy (OR 2.10, 95% CI 1.52-2.89), PEG tube placement (OR 1.88, 95% CI 1.45-2.45), and increased hospital length of stay (p < 0.001).

Conclusions: The overall incidence of severe AKI is relatively low (2.1%), but is associated with increased mortality and multiple markers of increased healthcare utilization following severe TBI.

Keywords: Acute kidney injury; Healthcare utilization; Traumatic brain injury.

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Conflict of interest statement

Conflicts of Interest: None

Figures

**Figure 1.**
Outcomes following development of severe AKI

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Association of Severe Acute Kidney Injury with Mortality and Healthcare Utilization Following Isolated Traumatic Brain Injury

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Association of Severe Acute Kidney Injury with Mortality and Healthcare Utilization Following Isolated Traumatic Brain Injury

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