SpringerLink
Log in

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

  • Original work
  • Published:
Neurocritical Care Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Rutland-Brown W, Langlois JA, Thomas KE, ** YL. Incidence of traumatic brain injury in the United States, 2003. J Head Trauma Rehabil. 2006;21:544–8.

    Article  Google Scholar 

  2. Saatman KE, Duhaime AC, Bullock R, et al. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008;25:719–38.

    Article  Google Scholar 

  3. Mascia L, Sakr Y, Pasero D, Payen D, Reinhart K, Vincent JL. Extracranial complications in patients with acute brain injury: a post hoc analysis of the SOAP study. Intensive Care Med. 2008;34:720–7.

    Article  Google Scholar 

  4. Jeremitsky E, Omert L, Dunham CM, Protetch J, Rodriguez A. Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma. 2003;54:312–9.

    Article  Google Scholar 

  5. Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136:1118–23.

    Article  CAS  Google Scholar 

  6. Krishnamoorthy V, Rowhani-Rahbar A, Gibbons EF, et al. Early systolic dysfunction following traumatic brain injury: a cohort study. Crit Care Med. 2017;45:1028–36.

    Article  Google Scholar 

  7. Moore EM, Bellomo R, Nichol A, Harley N, Macisaac C, Cooper DJ. The incidence of acute kidney injury in patients with traumatic brain injury. Ren Fail. 2010;32:1060–5.

    Article  Google Scholar 

  8. Maegele M. Coagulopathy after traumatic brain injury: incidence, pathogenesis, and treatment options. Transfusion. 2013;53(Suppl 1):28S–37S.

    Article  Google Scholar 

  9. Corral L, Javierre CF, Ventura JL, Marcos P, Herrero JI, Manez R. Impact of non-neurological complications in severe traumatic brain injury outcome. Crit Care. 2012;16:R44.

    Article  Google Scholar 

  10. Lee S, Hwang H, Yamal JM, et al. IMPACT probability of poor outcome and plasma cytokine concentrations are associated with multiple organ dysfunction syndrome following traumatic brain injury. J Neurosurg. 2019;131:1931–7.

    Article  CAS  Google Scholar 

  11. Lin CY, Chen YC. Acute kidney injury classification: AKIN and RIFLE criteria in critical patients. World J Crit Care Med. 2012;1:40–5.

    Article  Google Scholar 

  12. Haider AH, Hashmi ZG, Zafar SN, et al. Develo** best practices to study trauma outcomes in large databases: an evidence-based approach to determine the best mortality risk adjustment model. J Trauma Acute Care Surg. 2014;76:1061–9.

    Article  Google Scholar 

  13. Rosner MJ, Newsome HH, Becker DP. Mechanical brain injury: the sympathoadrenal response. J Neurosurg. 1984;61:76–86.

    Article  CAS  Google Scholar 

  14. Koiv L, Merisalu E, Zilmer K, Tomberg T, Kaasik AE. Changes of sympatho-adrenal and hypothalamo-pituitary-adrenocortical system in patients with head injury. Acta Neurol Scand. 1997;96:52–8.

    Article  CAS  Google Scholar 

  15. Rizoli SB, Jaja BN, Di Battista AP, et al. Catecholamines as outcome markers in isolated traumatic brain injury: the COMA-TBI study. Crit Care. 2017;21:37.

    Article  Google Scholar 

  16. McDonald SJ, Sharkey JM, Sun M, et al. Beyond the brain: peripheral interactions after traumatic brain injury. J Neurotrauma. 2020;37:770–81.

    Article  Google Scholar 

  17. Wiersema R, Eck RJ, Haapio M, et al. Burden of acute kidney injury and 90-day mortality in critically ill patients. BMC Nephrol. 2019;21:1.

    Article  Google Scholar 

  18. Ramtinfar S, Chabok SY, Chari AJ, Reihanian Z, Leili EK, Alizadeh A. Early detection of nonneurologic organ failure in patients with severe traumatic brain injury: multiple organ dysfunction score or sequential organ failure assessment? Indian J Crit Care Med. 2016;20:575–80.

    Article  Google Scholar 

  19. Erdman MJ, Riha H, Bode L, Chang JJ, Jones GM. Predictors of Acute kidney injury in neurocritical care patients receiving continuous hypertonic saline. Neurohospitalist. 2017;7:9–14.

    Article  Google Scholar 

  20. Wilcox CS. Regulation of renal blood flow by plasma chloride. J Clin Invest. 1983;71:726–35.

    Article  CAS  Google Scholar 

  21. Maguigan KL, Dennis BM, Hamblin SE, Guillamondegui OD. Method of hypertonic saline administration: effects on osmolality in traumatic brain injury patients. J Clin Neurosci. 2017;39:147–50.

    Article  CAS  Google Scholar 

  22. Zeng J, Tong W, Zheng P. Decreased risk of acute kidney injury with intracranial pressure monitoring in patients with moderate or severe brain injury. J Neurosurg. 2013;119:1228–32.

    Article  Google Scholar 

  23. Skrifvars MB, Moore E, Martensson J, et al. Erythropoietin in traumatic brain injury associated acute kidney injury: a randomized controlled trial. Acta Anaesthesiol Scand. 2019;63:200–7.

    Article  CAS  Google Scholar 

Download references

Funding

Dr. Krishnamoorthy received funding from the National Institutes of Health (K23 NS109274).

Author information

Authors and Affiliations

  1. Duke University Medical Center, Department of Anesthesiology, DUMC 3094, Duke University, Durham, NC, 27710, USA

    David Luu, Joseph Mathew, Michael L. James, Matt Fuller, Tetsu Ohnuma, Karthik Raghunathan, Jamie Privratsky, Raquel Bartz & Vijay Krishnamoorthy

  2. Department of Neurosurgery, Duke University, Durham, USA

    Jordan Komisarow & John Sampson

  3. Harborview Injury Prevention and Research Center, University of Washington, Seattle, USA

    Brianna M. Mills & Monica S. Vavilala

  4. Departments of Anesthesiology and Pain Medicine, University of Washington, Seattle, USA

    Monica S. Vavilala

  5. Departments of Neurology, Duke University, Durham, USA

    Daniel T. Laskowitz & Michael L. James

  6. Departments of Medicine, Duke University, Durham, USA

    Adrian Hernandez

  7. Critical Care and Perioperative Population Health Research (CAPER) Unit, Department of Anesthesiology, Duke University, Durham, USA

    David Luu, Jordan Komisarow, Michael L. James, Matt Fuller, Tetsu Ohnuma, Karthik Raghunathan, Jamie Privratsky, Raquel Bartz & Vijay Krishnamoorthy

  8. Department of Epidemiology, University of Washington, Seattle, USA

    Brianna M. Mills

  9. Population Health Sciences, Duke University, Durham, USA

    Adrian Hernandez, Karthik Raghunathan & Vijay Krishnamoorthy

Authors
  1. David Luu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jordan Komisarow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brianna M. Mills
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica S. Vavilala
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel T. Laskowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joseph Mathew
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael L. James
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Adrian Hernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. John Sampson
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matt Fuller
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tetsu Ohnuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Karthik Raghunathan
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jamie Privratsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Raquel Bartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Vijay Krishnamoorthy
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the conception and design of the work, analysis, interpretation, drafting the manuscript and have given final approval of the published work.

Corresponding author

Correspondence to Vijay Krishnamoorthy.

Ethics declarations

Conflict of interest

Authors declare no conflict of interest.

Ethical Approval/Informed Consent

The NTDB is fully de-identified and, therefore, exempt from Institutional Review Board (IRB) review and informed consent by the Duke University Health System IRB.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic Supplementary Material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 56 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luu, D., Komisarow, J., Mills, B.M. et al. Association of Severe Acute Kidney Injury with Mortality and Healthcare Utilization Following Isolated Traumatic Brain Injury. Neurocrit Care 35, 434–440 (2021). https://doi.org/10.1007/s12028-020-01183-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-020-01183-z

Keywords

Search

Navigation