Gao Yu, Li Yong, Zhou Hai, Wang Xin, Wang Guojun, Zhu Lin
Department of Critical Care Medicine, Binhai County People's Hospital, Affiliated Binhai Hospital, Kangda College of Nanjing Medical University, Yancheng, Jiangsu, China.
Department of Neurosurgery, Binhai County People's Hospital, Affiliated Binhai Hospital, Kangda College of Nanjing Medical University, Yancheng, Jiangsu, China.
Front Neurol. 2025 Feb 18;15:1407107. doi: 10.3389/fneur.2024.1407107. eCollection 2024.
Acute kidney injury (AKI) and coagulation disorders are two common complications of traumatic brain injury (TBI) that are associated with poor prognosis. However, the relationship between early coagulation disorders and the risk of severe AKI in TBI patients remains unclear. This study aimed to explore the association between early coagulation disorders and the risk of severe AKI in TBI patients admitted to the intensive care unit (ICU).
In this retrospective cohort study, adults diagnosed with TBI were selected from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The outcome was the risk of severe AKI within 7 days of ICU admission in TBI patients. Covariates including sociodemographic information, vital signs, scoring systems, and laboratory parameters were extracted from the database. Univariable and multivariable Cox proportional hazard regression models were used to assess the association between early coagulation disorders and the risk of severe AKI within 7 days of admission to the ICU in TBI patients. Subgroup analyses based on age and the Glasgow Coma Scale (GCS) score were further conducted to assess the association.
A total of 846 patients were finally included, of whom 187 (22.10%) had severe AKI. After adjusting for all covariates, the TBI patients with early coagulation disorders had a higher risk of developing severe AKI within 7 days of ICU admission compared to the TBI patients without early coagulation disorders (hazard ratio (HR) = 1.40, 95% confidence interval (CI): 1.04-1.89), particularly among those aged ≥65 years (HR = 1.46, 95%CI: 1.01-2.04) and those with a GCS score ≤ 13 (HR = 1.91, 95%CI: 1.16-3.15).
TBI patients with early coagulation disorders had a higher risk of developing severe AKI within 7 days of ICU admission. This may serve as a promising biomarker and could be helpful for managing kidney health in TBI patients.
急性肾损伤（AKI）和凝血功能障碍是创伤性脑损伤（TBI）的两种常见并发症，与预后不良相关。然而，TBI患者早期凝血功能障碍与严重AKI风险之间的关系仍不明确。本研究旨在探讨入住重症监护病房（ICU）的TBI患者早期凝血功能障碍与严重AKI风险之间的关联。
在这项回顾性队列研究中，从重症监护医学信息数据库（MIMIC）-IV中选取诊断为TBI的成年人。结局指标是TBI患者入住ICU后7天内发生严重AKI的风险。从数据库中提取包括社会人口统计学信息、生命体征、评分系统和实验室参数在内的协变量。采用单变量和多变量Cox比例风险回归模型评估TBI患者早期凝血功能障碍与入住ICU后7天内发生严重AKI风险之间的关联。进一步基于年龄和格拉斯哥昏迷量表（GCS）评分进行亚组分析，以评估这种关联。
最终纳入846例患者，其中187例（22.10%）发生严重AKI。在对所有协变量进行调整后，与无早期凝血功能障碍的TBI患者相比，有早期凝血功能障碍的TBI患者在入住ICU后7天内发生严重AKI的风险更高（风险比（HR）=1.40，95%置信区间（CI）：1.04 - 1.89），特别是在年龄≥65岁的患者中（HR = 1.46，95%CI：1.01 - 2.04）以及GCS评分≤13的患者中（HR = 1.91，95%CI：1.16 - 3.15）。
有早期凝血功能障碍的TBI患者在入住ICU后7天内发生严重AKI的风险更高。这可能是一个有前景的生物标志物，有助于管理TBI患者的肾脏健康。
