PURPOSE

Non-steroidal anti-inflammatory drugs (NSAIDs) are increasingly utilized in trauma patients, particularly those with critical chest trauma who are susceptible to significant blood loss, leading to renal hypoperfusion. Acute kidney injury (AKI) is known to carry a poor prognosis in chest trauma patients. Therefore, investigating the potential association between NSAID use and AKI risk in critical patients with chest trauma is crucial.

METHODS

We selected patients admitted to the intensive care unit (ICU) with chest trauma from the Medical Information Mart for Intensive Care III (MIMIC-III) dataset (2001-2012) and the Medical Information Mart for Intensive Care IV (MIMIC-IV) dataset (2013-2019). Propensity score matching (PSM) was used to match patients receiving NSAIDs with those not receiving treatment. Logistic regression was employed to assess the association between different types of NSAIDs and AKI in these patients.

RESULTS

In MIMIC-IV, NSAID use significantly increased the risk of AKI in critical patients with chest trauma (OR 1.99; 95% CI 1.04 to 3.85). Subgroup analysis revealed that aspirin significantly increased AKI risk in both MIMIC-III (OR 1.81; 95% CI 1.02 to 3.2) and MIMIC-IV (OR 2.47; 95% CI 1.26 to 4.85). However, ibuprofen and ketorolac use were not associated with AKI in these patients.

CONCLUSION

We observed a significant association between aspirin use and an elevated risk of AKI in critical patients with chest trauma. These findings suggest that pain management strategies involving ibuprofen and ketorolac may be more appropriate for this patient population.