Chan Chieh-Kai, Chi Chun-Yi, Lai Tai-Shuan, Huang Tao-Min, Chou Nai-Kuan, Huang Yi-Ping, Prowle John R, Wu Vin-Cent, Chen Yung-Ming
Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin Chu County, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Zhong-Zheng District, Taipei, 100, Taiwan.
Sci Rep. 2020 Nov 25;10(1):20572. doi: 10.1038/s41598-020-77556-3.
Acute kidney injury (AKI) is a frequent complication of traumatic injury; however, long-term outcomes such as mortality and end-stage kidney disease (ESKD) have been rarely reported in this important patient population. We compared the long-term outcome of vehicle-traumatic and non-traumatic AKI requiring renal replacement therapy (AKI-RRT). This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Vehicle-trauma patients who were suffered from vehicle accidents developing AKI-RRT during hospitalization were identified, and matching non-traumatic AKI-RRT patients were identified between 2000 and 2010. The incidences of ESKD, 30-day, and long-term mortality were evaluated, and clinical and demographic associations with these outcomes were identified using Cox proportional hazards regression models. 546 vehicle-traumatic AKI-RRT patients, median age 47.6 years (interquartile range: 29.0-64.3) and 76.4% male, were identified. Compared to non-traumatic AKI-RRT, vehicle-traumatic AKI-RRT patients had longer length of stay in hospital [median (IQR):15 (5-34) days vs. 6 (3-11) days; p < 0.001). After propensity matching with non-traumatic AKI-RRT cases with similar demographic and clinical characteristics. Vehicle-traumatic AKI-RRT patients had lower rates of long-term mortality (adjusted hazard ratio (HR), 0.473; 95% CI, 0.392-0.571; p < 0.001), but similar rates of ESKD (HR, 1.166; 95% CI, 0.829-1.638; p = 0.377) and short-term risk of death (HR, 1.134; 95% CI, 0.894-1.438; p = 0.301) as non-traumatic AKI-RRT patients. In competing risk models that focused on ESKD, vehicle-traumatic AKI-RRT patients were associated with lower ESKD rates (HR, 0.552; 95% CI, 0.325-0.937; p = 0.028) than non-traumatic AKI-RRT patients. Despite severe injuries, vehicle-traumatic AKI-RRT patients had better long-term survival than non-traumatic AKI-RRT patients, but a similar risk of ESKD. Our results provide a better understanding of long-term outcomes after vehicle-traumatic AKI-RRT.
急性肾损伤（AKI）是创伤性损伤的常见并发症；然而，在这一重要患者群体中，诸如死亡率和终末期肾病（ESKD）等长期预后情况鲜有报道。我们比较了需要肾脏替代治疗（AKI-RRT）的车祸创伤性AKI和非创伤性AKI的长期预后。这项全国性队列研究使用了台湾国民健康保险研究数据库的数据。确定了在住院期间因车祸发生AKI-RRT的车祸创伤患者，并在2000年至2010年间确定了匹配的非创伤性AKI-RRT患者。评估了ESKD的发生率、30天和长期死亡率，并使用Cox比例风险回归模型确定了与这些预后相关的临床和人口统计学因素。共确定了546例车祸创伤性AKI-RRT患者，中位年龄47.6岁（四分位间距：29.0-64.3），男性占76.4%。与非创伤性AKI-RRT相比，车祸创伤性AKI-RRT患者的住院时间更长[中位（IQR）：15（5-34）天 vs. 6（3-11）天；p＜0.001]。在与具有相似人口统计学和临床特征的非创伤性AKI-RRT病例进行倾向匹配后。车祸创伤性AKI-RRT患者的长期死亡率较低（调整后风险比[HR]，0.473；95%置信区间，0.392-0.571；p＜0.001），但ESKD发生率（HR，1.166；95%置信区间，0.829-1.638；p = 0.377）和短期死亡风险（HR，1.134；——95%置信区间，0.894-1.438；p = 0.301）与非创伤性AKI-RRT患者相似。在关注ESKD的竞争风险模型中，车祸创伤性AKI-RRT患者的ESKD发生率（HR，0.552；95%置信区间，0.325-0.937；p = 0.028）低于非创伤性AKI-RRT患者。尽管伤势严重，但车祸创伤性AKI-RRT患者的长期生存率高于非创伤性AKI-RRT患者，但ESKD风险相似。我们的研究结果有助于更好地了解车祸创伤性AKI-RRT后的长期预后。
