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创伤性脑损伤与急性肾损伤——结局及相关危险因素

Traumatic Brain Injury and Acute Kidney Injury-Outcomes and Associated Risk Factors.

作者信息

Barea-Mendoza Jesús Abelardo, Chico-Fernández Mario, Quintana-Díaz Manuel, Serviá-Goixart Lluís, Fernández-Cuervo Ana, Bringas-Bollada María, Ballesteros-Sanz María Ángeles, García-Sáez Íker, Pérez-Bárcena Jon, Llompart-Pou Juan Antonio

机构信息

UCI de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.

Servicio de Medicina Intensiva, Hospital Universitario La Paz, 28029 Madrid, Spain.

出版信息

J Clin Med. 2022 Dec 5;11(23):7216. doi: 10.3390/jcm11237216.

Abstract

Our objective was to analyze the contribution of acute kidney injury (AKI) to the mortality of isolated TBI patients and its associated risk factors. Observational, prospective and multicenter registry (RETRAUCI) methods were used, from March 2015 to December 2019. Isolated TBI was defined as abbreviated injury scale (AIS) ≥ 3 head with no additional score ≥ 3. A comparison of groups was conducted using the Wilcoxon test, chi-square test or Fisher's exact test, as appropriate. A multiple logistic regression analysis was conducted to analyze associated risk factors in the development of AKI. For the result, overall, 2964 (30.2%) had AIS head ≥ 3 with no other area with AIS ≥ 3. The mean age was 54.7 (SD 19.5) years, 76% were men, and the ground-level falls was 49.1%. The mean ISS was 18.4 (SD 8). The in-hospital mortality was 22.2%. Up to 310 patients (10.6%) developed AKI, which was associated with increased mortality (39% vs. 17%, adjusted OR 2.2). Associated risk factors (odds ratio (OR) (95% confidence interval)) were age (OR 1.02 (1.01-1.02)), hemodynamic instability (OR 2.87 to OR 5.83 (1.79-13.1)), rhabdomyolysis (OR 2.94 (1.69-5.11)), trauma-associated coagulopathy (OR 1.67 (1.05-2.66)) and transfusion of packed red-blood-cell concentrates (OR 1.76 (1.12-2.76)). In conclusion, AKI occurred in 10.6% of isolated TBI patients and was associated with increased mortality.

摘要

我们的目标是分析急性肾损伤(AKI)对单纯性创伤性脑损伤(TBI)患者死亡率的影响及其相关危险因素。采用观察性、前瞻性多中心登记研究(RETRAUCI)方法,研究时间为2015年3月至2019年12月。单纯性TBI定义为简明损伤定级(AIS)头部损伤≥3级且无其他部位损伤评分≥3级。根据情况,使用Wilcoxon检验、卡方检验或Fisher精确检验进行组间比较。进行多因素logistic回归分析以分析AKI发生的相关危险因素。结果显示,总体上,2964例(30.2%)患者AIS头部损伤≥3级且无其他区域AIS≥3级。平均年龄为54.7岁(标准差19.5),76%为男性,平地跌倒占49.1%。平均损伤严重度评分(ISS)为18.4(标准差8)。住院死亡率为22.2%。多达310例患者(10.6%)发生AKI,这与死亡率增加相关(39%对17%,校正比值比2.2)。相关危险因素(比值比(OR)(95%置信区间))包括年龄(OR 1.02(1.01 - 1.02))、血流动力学不稳定(OR 2.87至OR 5.83(1.79 - 13.1))、横纹肌溶解(OR 2.94(

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6950/9739137/5926d098488f/jcm-11-07216-g001.jpg

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