Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 16;6(1):e000635.
doi: 10.1136/tsaco-2020-000635. eCollection 2021.

Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study

Nasim Ahmed  1 , Roy O Mathew  2 , Yenhong Kuo  3 , Arif Asif  4
Affiliations

Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study

Nasim Ahmed et al. Trauma Surg Acute Care Open. .

Abstract

Background: The development of acute kidney injury (AKI) in trauma patients has been associated with an almost threefold increase in overall mortality. Many risk factors of mortality in severe AKI have been reported, but majority of the studies have been performed using a single-center data or have a small sample size. The purpose of this study was to identify the risk factors of mortality in severe AKI trauma patients.

Methods: The study was performed using 2012-2016 American College of Surgeon Trauma Quality Improvement Program data, a national database of trauma patients in the USA.All adult trauma patients aged 16 to 89 years old, admitted to the hospital and who developed a severe AKI were included in the study. A p value of <0.05 was considered statistically significant.

Results: Out of 9309 trauma patients who developed severe AKI, 2641 (28.08%) died. There were significant differences found in bivariate analysis between the groups who died and who survived after developing a severe AKI. Multivariable analysis showed male sex, older age, higher Injury Severity Score, lower Glasgow Coma Scale, presence of hypotension (systolic blood pressure<90 mm Hg) and coagulopathy were all significantly associated with in-hospital mortality. The area under the curve value was 0.706 and the 95% CI was 0.68 to 0.727.

Discussion: Current analysis showed certain patients' characteristics are associated with higher mortality in patients with severe AKI. Prompt identification and aggressive monitoring and management in high-risk patients may result in reduced mortality.

Level of evidence: IV.

Study type: Observational cohort study.

Keywords: acute kidney injury; mortality; multiple trauma.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Risk score versus predictability of mortality. AKI, acute kidney injury.
Figure 2
Figure 2
ROC curve for prognostic model performance for predicting mortality in severe AKI. AKI, acute kidney injury; AUC, area under the curve; ROC, receiver operating characteristic.
Figure 3
Figure 3
Observed versus fitted average mortality in severe AKI. AKI, acue kidney injury.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Norton R, Kobusingye O. Injuries. N Engl J Med 2013;368:1723–30. 10.1056/NEJMra1109343 - DOI - PubMed
    1. Koh EY, Oyeniyi BT, Fox EE, Scerbo M, Tomasek JS, Wade CE, Holcomb JB. Trends in potentially preventable trauma deaths between 2005-2006 and 2012-2013. Am J Surg 2019;218:501–6. 10.1016/j.amjsurg.2018.12.022 - DOI - PubMed
    1. Bihorac A, Delano MJ, Schold JD, Lopez MC, Nathens AB, Maier RV, Layon AJ, Baker HV, Moldawer LL. Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients. Ann Surg 2010;252:158–65. 10.1097/SLA.0b013e3181deb6bc - DOI - PMC - PubMed
    1. Ahmed N, Mathew RO, Kuo Y-H, Md AA. Risk of severe acute kidney injury in multiple trauma patients: risk estimation based on a national trauma dataset. Injury 2020;51:45–50. 10.1016/j.injury.2019.11.008 - DOI - PubMed
    1. Bolanos JA, Yuan CM, Little DJ, Oliver DK, Howard SR, Abbott KC, Olson SW. Outcomes after post-traumatic AKI requiring RRT in United States military service members. Clin J Am Soc Nephrol 2015;10:1732–9. 10.2215/CJN.00890115 - DOI - PMC - PubMed