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Open Access

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

Nasim Ahmed, Roy O Mathew, Yenhong Kuo, Arif Asif
DOI: 10.1136/tsaco-2020-000635 Published 16 February 2021
Nasim Ahmed
1Surgery, Division of Trauma, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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Roy O Mathew
2Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Yenhong Kuo
3Research, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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Arif Asif
4Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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  • Figure 1
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    Figure 1

    Risk score versus predictability of mortality. AKI, acute kidney injury.

  • Figure 2
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    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.

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    Figure 3

    Observed versus fitted average mortality in severe AKI. AKI, acue kidney injury.

Tables

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  • Table 1

    Bivariate analysis of patients with severe AKI who died and who survived

    VariableTotal patients (n=9309)Survived
    (n=6695)
    Died
    (n=2614)
    P Value
    Age (years), median (Q1–Q3)61 (43–61)60 (42–75)62 (46–76)<0.001
     Race, n (%)0.033
     American Indian64 (0.7)52 (0.8)12 (0.5)
     Asian186 (2)117 (1.7)69 (2.6)
     Black or African American1801 (19.3)1319 (19.7)482 (18.4)
     Native Hawaiian or other Pacific Islander17 (0.2)13 (0.2)4 (0.2)
     Other race642 (6.9)452 (6.8)190 (7.3)
     White6599 (70.9)4742 (70.8)1857 (71)
    Race (white), n (%)6599 (70.9)4742 (70.8)1857 (71)0.86
    Sex, n (%)<0.001
     Female2457 (26.4)1867 (27.9)590 (22.6)
     Male6852 (73.6)4828 (72.1)2024 (77.4)
    Hypotension, n (%)1182 (12.7)743 (11.1)439 (16.8)<0.001
     SBP (mm Hg), median (Q1–Q3)130 (105–152)132 (108–154)122.5 (99–148)<0.001
     Pulse, median (Q1–Q3)93 (78–112)92 (78–111)95 (78–116)0.001
     ISS, median (Q1–Q3)18 (10–29)17 (9–26)25 (16–34)<0.001
     GCS, median (Q1–Q3)15 (10–15)15 (13–15)14 (3–15)<0.001
     Injury type, n (%)0.036
    Blunt8306 (89.2)5945 (88.8)2361 (90.3)
    Penetrating1003 (10.8)750 (11.2)253 (9.7)
     Mechanism of injury, n (%)<0.001
     All others37 (0.4)24 (0.4)13 (0.5)
     Bicycle hit by107 (1.1)65 (1)42 (1.6)
     Fall3595 (38.6)2722 (40.7)873 (33.4)
     GSW839 (9)622 (9.3)217 (8.3)
     Machinery85 (0.9)65 (1)20 (0.8)
     Motorcycle823 (8.8)592 (8.8)231 (8.8)
     MVT2538 (27.3)1722 (25.7)816 (31.2)
     Other transport519 (5.6)384 (5.7)135 (5.2)
     Pedestrian hit by603 (6.5)372 (5.6)231 (8.8)
     Stab wound163 (1.8)127 (1.9)36 (1.4)
     Comorbidities, n (%)
     Diabetes mellitus2384 (25.6)1764 (26.3)620 (23.7)0.01
     Hypertension requiring medication4517 (48.5)3346 (50)1171 (44.8)<0.001
     Congestive heart failure908 (9.8)657 (9.8)251 (9.6)0.787
     Current smoker1534 (16.5)1156 (17.3)378 (14.5)0.001
     Use of anticoagulation/bleeding disorder1200 (12.9)797 (11.9)403 (15.4)<0.001
     Functionally dependent health status366 (3.9)271 (4)95 (3.6)0.388
     History of myocardial infarction340 (3.7)267 (4)73 (2.8)0.007
     Obesity872 (9.4)644 (9.6)228 (8.7)0.195
     Respiratory disease647 (7)465 (6.9)182 (7)1
    • AKI, acute kidney injury; GCS, Glasgow Coma Scale; GSW, Gun shot wound; ISS, Injury Severity Score; MVT, motor vehicle traffic accident; n, number of patients; SBP, systolic blood pressure; SW, stab wound.

  • Table 2

    Risk factors of mortality in patients with severe AKI

    Variableβ coefficientOR95 % CI for ORP value
    (Intercept)−2.720.070.05 to 0.08<0.0001
    Male vs. female0.171.191.04 to 1.350.0082
    White (no vs. yes)0.121.131.00 to 1.280.0516
    Hypotension (yes vs. no)0.161.171.00 to 1.370.0499
    Coagulopathy (yes vs. no)0.401.491.28 to 1.75<0.0001
    Age (years)
     45–54 vs. 16–440.411.511.25 to 1.82<0.0001
     55–64 vs. 16–440.822.251.89 to 2.68<0.0001
     65–74 vs. 16–440.972.632.19 to 3.17<0.0001
     75–89 vs. 16–441.153.142.62 to 3.76<0.0001
    ISS
     15–24 vs. 4–140.581.781.53 to 2.06<0.0001
     25–34 vs. 4–141.042.812.41 to 3.28<0.0001
     35–44 vs. 4–141.353.853.12 to 4.76<0.0001
     45–75 vs. 4–141.685.364.17 to 6.89<0.0001
    GCS score
     3–8 vs. 13–150.832.302.01 to 2.63<0.0001
     9–12 vs. 13–150.261.301.03 to 1.640.0275
    • Hypotension: systolic blood pressure<90 mm Hg.

    • AKI, acute kidney injury; GCS, Glasgow Coma Scale; ISS, Injury Severity Score.

  • Table 3

    Risk of mortality score with severe AKI

    CoefficientScore
    Male0.172622
    Nonwhite0.121361
    Hypotension0.157292
    Coagulopathy0.400564
    Age (years)
     44–540.414434
     54–640.815158
     64–740.9709610
     74–891.1467511
    ISS
     14–240.57796
     24–341.036610
     34–441.3456813
     44–751.6820417
    GCS score
     3–80.829168
     8–120.261453
    • Hypotension: systolic blood pressure<90 mm Hg.

    • AKI, acute kidney injury; GCS, Glasgow Coma Scale; ISS, Injury severity score.

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Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study
Nasim Ahmed, Roy O Mathew, Yenhong Kuo, Arif Asif
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000635; DOI: 10.1136/tsaco-2020-000635

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Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study
Nasim Ahmed, Roy O Mathew, Yenhong Kuo, Arif Asif
Trauma Surg Acute Care Open Feb 2021, 6 (1) e000635; DOI: 10.1136/tsaco-2020-000635
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Risk of in-hospital mortality in severe acute kidney injury after traumatic injuries: a national trauma quality program study
Nasim Ahmed, Roy O Mathew, Yenhong Kuo, Arif Asif
Trauma Surgery & Acute Care Open Feb 2021, 6 (1) e000635; DOI: 10.1136/tsaco-2020-000635
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