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

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.