Acute kidney injury in survivors of surgery for severe traumatic brain injury: Incidence, risk factors, and outcome from a tertiary neuroscience center in India
Acute kidney injury in survivors of surgery for severe traumatic brain injury: Incidence, risk factors, and outcome from a tertiary neuroscience center in India
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DOI：
10.3109/02688697.2015.1016892
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发表时间：
2015-01-01
影响因子：
1.1
通讯作者：
Rao, Ganne S. Umamaheswara
中科院分区：
文献类型：
--
作者：
Ahmed, Masud;Sriganesh, Kamath;Rao, Ganne S. Umamaheswara
背景急性肾损伤（阿基）等非神经系统并发症会影响创伤性脑损伤（TBI）的结局。本研究旨在分析严重TBI手术患者阿基的发生率、预测因素和影响。方法.我们回顾性分析了395例因严重TBI接受手术并在1年内存活出院的患者的数据。其中，95例患者最终纳入分析。他们的人口统计学数据，实验室参数和临床过程进行了审查。阿基的诊断和分期采用急性肾损伤网络（AKIN）标准。结果阿基的发生率为11.6%（11例患者）。在11例阿基患者中，7例为I期（63.6%），3例为II期（27.3%），1例为III期（9.1%）。9例患者（81.8%）在入院后5天内发生阿基。氨基糖苷类药物治疗与阿基的发生相关。无死亡，无患者需要肾脏替代治疗（RRT）。所有患者的肾功能在出院前均恢复至基线水平。出院时，与未发生阿基的患者相比，AKI患者的住院时间和重症监护室（ICU）时间更长，格拉斯哥昏迷评分（GCS）更低。结论在需要手术干预的重度TBI患者中，近12%发生了不需要RRT的可逆性阿基。氨基糖苷类药物治疗是阿基发生的唯一预测因素。阿基患者机械通气时间较长，ICU和住院时间较长，出院时GCS较差。
Background. Non-neurological complications like acute kidney injury (AKI) can affect outcome of traumatic brain injury (TBI). This study aims to analyze the incidence, predictive factors, and impact of AKI in operated patients with severe TBI. Methods. We retrospectively reviewed the data of 395 patients who underwent surgery for severe TBI and survived to be discharged from the hospital over a 1-year period. Of these, 95 patients were finally included in the analysis. Their demographic data, laboratory parameters, and clinical courses were reviewed. Diagnosis and staging of AKI was made using Acute Kidney Injury Network (AKIN) criteria. Results. The incidence of AKI was 11.6% (11 patients). Out of the11 patients who had AKI, 7 were in stage I (63.6%), 3 were in stage II (27.3%), and 1 in stage III (9.1%). Nine Patients (81.8%) developed AKI within 5 days of admission. Aminoglycoside therapy had an association with occurrence of AKI. There was no mortality and none of the patients required renal replacement therapy (RRT). Renal function of all these patients returned to baseline before hospital discharge. Hospital stay and intensive care unit (ICU) stay were longer and Glasgow coma scale (GCS) was lower in patients with AKI when compared with patients without AKI group at discharge. Conclusion. Reversible AKI without need for RRT occurred in nearly12% of patients with severe TBI requiring surgical intervention. Aminoglycoside therapy was the only predictive factor for the occurrence of AKI. Patients with AKI have a longer period of mechanical ventilation, longer ICU and hospital stay, and poorer GCS at discharge.