Kiwan Omar, Finnimore Elizabeth, James Benjamin D, Robinson Paul W, Al-Kalbani Mohammed, Bonfield Becky, Green Darren
University of Manchester, Manchester, United Kingdom.
Salford Royal Hospital, Salford, United Kingdom.
PLoS One. 2025 Jul 2;20(7):e0326780. doi: 10.1371/journal.pone.0326780. eCollection 2025.
Guidelines on risk assessment for acute kidney injury (AKI) are generalised and may not adequately consider atypical presentations such as trauma. Older people are largely absent in past studies of AKI after trauma, meaning there is an evidence gap of trauma-associated AKI risk factors in older people.
We undertook a retrospective analysis of 2,211 ward-level hospital trauma admissions during 2014-2022. We identified risk factors associated with AKI in people aged ≥65 years and <65 years, and established the clinical impact of AKI in older and younger trauma cases.
In those aged ≥65 years, parameters significantly associated with AKI were age, CKD, heart failure, infection, lower limb trauma. In people <65 years, the significant risk factors were age, CKD, liver disease, coronary disease, and pelvic trauma. In both age groups, AKI was associated with a greater risk of length of stay >14 days but not mortality.
This study shows that risk factors for AKI in older trauma patients are comparable to those found in most guidelines for AKI risk assessment, with the addition of lower limb trauma. This factor could be considered as a useful adjunct in trauma AKI risk assessment tools to facilitate stratified care.
急性肾损伤（AKI）风险评估指南较为笼统，可能未充分考虑创伤等非典型表现。在以往关于创伤后急性肾损伤的研究中，老年人大多未被纳入，这意味着老年人创伤相关急性肾损伤风险因素存在证据空白。
我们对2014年至2022年期间2211例病房级医院创伤入院病例进行了回顾性分析。我们确定了年龄≥65岁和<65岁人群中与急性肾损伤相关的风险因素，并确定了急性肾损伤在老年和年轻创伤病例中的临床影响。
在年龄≥65岁的人群中，与急性肾损伤显著相关的参数有年龄、慢性肾脏病、心力衰竭、感染、下肢创伤。在年龄<65岁的人群中，显著的风险因素有年龄、慢性肾脏病、肝病、冠心病和骨盆创伤。在两个年龄组中，急性肾损伤与住院时间>14天的风险增加相关，但与死亡率无关。
本研究表明，老年创伤患者急性肾损伤的风险因素与大多数急性肾损伤风险评估指南中的因素相当，此外还有下肢创伤。这一因素可被视为创伤急性肾损伤风险评估工具中的有用辅助因素，以促进分层护理。
