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Open Access

Importance of duration of acute kidney injury after severe trauma: a cohort study

Gabrielle E Hatton, John A Harvin, Charles E Wade, Lillian S Kao
DOI: 10.1136/tsaco-2021-000689 Published 27 May 2021
Gabrielle E Hatton
Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
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John A Harvin
Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
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Charles E Wade
Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
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Lillian S Kao
Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
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Article Figures & Data

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    Figure 1

    Duration of acute kidney injury (AKI), raw data.

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    Figure 2

    Acute kidney injury (AKI) duration and outcomes.

Tables

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  • Table 1

    Characteristics of study participants

    All patients (n=7049)No AKI
    (n=3896)
    Short-duration AKI (n=2303)Long-duration AKI (n=850)P value*
    Age (years)41 (26–58)36 (24–53)46 (29–61)53 (35–70)<0.001
    Male sex (%)5087 (72)3060 (79)1507 (65)520 (61)<0.001
    Race/ethnicity (%)    <0.001
     White3685 (52)1894 (49)1273 (55)518 (61)
     Black1167 (17)762 (20)301 (13)104 (12)
     Hispanic1560 (22)906 (23)493 (21)161 (19)
     Asian113 (2)62 (2)43 (2)8 (1)
    Blunt mechanism of injury (%)5974 (85)3238 (83)1980 (86)756 (89)<0.001
    Injury Severity Score20 (13–29)19 (12–29)22 (13–29)21 (13–29)0.002
    Arrival systolic blood pressure (mm Hg)122 (101–142)124 (105–142)120 (98–140)122 (99–144)<0.001
    Arrival heart rate (beats/min)97 (81–114)96 (81–114)98 (82–115)95 (80–113)0.02
    Arrival creatinine (mg/dL)1.2 (0.9–1.4)1 (0.9–1.2)1.4 (1.2–1.6)1.5 (1.3–1.9)<0.001
    Arrival hemoglobin (g/dL)12.9 (11.3–14.4)13.2 (11.5–14.5)12.7 (11–14.1)12.5 (10.9–14)<0.001
    Arrival base excess−4 (−1 to −8)−4 (−7 to −1)−5 (−8 to −2)−5 (−9 to −2)<0.001
    Emergent operation required (%)2188 (31)1210 (31)719 (31)259 (31)0.9
    AKI incidence (%)3153 (45)––––
    AKI on arrival (%)2144 (31) 1526 (66)640 (75)<0.001
    AKI onset >48 h (%)967 (14) 325 (14)23 (6)<0.001
    AKI duration0 (0–1) 1 (1–2)4 (3–6)<0.001
    Highest AKI stage (%) –  <0.001
     No AKI3896 (55) ––
     Stage 12082 (30) 1953 (85)129 (15)
     Stage 2636 (9) 300 (13)336 (40)
     Stage 3435 (6) 50 (2)385 (45)
    Need for renal replacement therapy (%)158 (2)–0158 (19)–
    LOS <1 week (%)2245 (32)1335 (34)665 (29)245 (29)<0.001
     Discharged (%)1770 (25)1128 (29)474 (21)168 (20)
     Mortality (%)475 (7)207 (5)191 (8)77 (9)
    Discharge disposition (%)    <0.001
     Home3525 (50)2131 (55)1084 (47)310 (36)
     Rehabilitation1057 (15)609 (16)347 (15)101 (12)
     LTC or SNF1153 (16)504 (13)231 (10)231 (27)
     Death706 (10)303 (8)255 (11)148 (17)
     Other608 (9)349 (9)386 (17)60 (7)
    Hospital-free days17 (4–24)18 (7–24)16 (3–22)12 (0–22)<0.001
    In-hospital mortality (%)706 (10)303 (8)255 (11)148 (17)<0.001
    • Continuous data presented as median (IQR).

    • *Kruskal-Wallis or χ2 test comparing three AKI groups.

    • AKI, acute kidney injury; LOS, length of stay; LTC, long-term care facility; SNF, skilled nursing facility.

  • Table 2

    Association between AKI metrics and outcomes on multivariable analyses

    AKI incidenceAKI stage (per stage)AKI duration (per day)
    Prolonged hospitalization among survivors1.27 (1.14 to 1.41), p<0.0011.23 (1.17 to 1.30), p<0.0011.04 (1.02 to 1.08), p=0.005
    Discharge destination other than home1.06 (1.01 to 1.11), p=0.031.07 (1.05 to 1.10), p<0.0011.03 (1.01 to 1.04), p<0.001
    Mortality1.21 (1.05 to 1.40), p=0.0081.24 (1.15 to 1.33), p<0.0011.34 (1.22 to 1.44), p<0.001
    • Findings reported as rate ratios (95% CI).

    • Adjusted for arrival systolic blood pressure, Injury Severity Score, and patient age.

    • AKI, acute kidney injury.

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Importance of duration of acute kidney injury after severe trauma: a cohort study
Gabrielle E Hatton, John A Harvin, Charles E Wade, Lillian S Kao
Trauma Surg Acute Care Open May 2021, 6 (1) e000689; DOI: 10.1136/tsaco-2021-000689

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Importance of duration of acute kidney injury after severe trauma: a cohort study
Gabrielle E Hatton, John A Harvin, Charles E Wade, Lillian S Kao
Trauma Surg Acute Care Open May 2021, 6 (1) e000689; DOI: 10.1136/tsaco-2021-000689
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Importance of duration of acute kidney injury after severe trauma: a cohort study
Gabrielle E Hatton, John A Harvin, Charles E Wade, Lillian S Kao
Trauma Surgery & Acute Care Open May 2021, 6 (1) e000689; DOI: 10.1136/tsaco-2021-000689
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