Acute kidney injury in critically ill patients with traumatic brain injury: A single-center retrospective cohort study

doi:10.5492/wjccm.v14.i4.110079

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World Journal of Critical Care Medicine

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Crit Care Med. Dec 9, 2025; 14(4): 110079
Published online Dec 9, 2025. doi: 10.5492/wjccm.v14.i4.110079

Acute kidney injury in critically ill patients with traumatic brain injury: A single-center retrospective cohort study

Bhushan Sudhakar Wankhade, Mohamed Hamed Ibrahim Ali El Kholi, Zeyad Faoor Alrais, Adel Elsaid Salem Elkhouly, Gopala Arun Kumar Naidu, Alim Akbar Patel, Mohamed Sameer, Mohammed Shahid Abbas, Nowar Nouralla Fadol Elbasier, Aala Fadlalla El Hadi

Bhushan Sudhakar Wankhade, Mohamed Hamed Ibrahim Ali El Kholi, Zeyad Faoor Alrais, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates

Author contributions: Wankhade BS and El Kholi MHIA planned the methodology; Wankhade BS, El Kholi MHIA, and Alrais ZF Elkhouly AES conducted the conceptualization and project administration; Naidu GAK, Patel AA, Sameer M, Abbas MS, Elbasier NNF, and El Hadi AF performed the data curation and formal analyses; Wankhade BS, El Kholi MHIA, Alrais ZF, Elkhouly AES, Naidu GAK, Patel AA, Sameer M, Abbas MS, Elbasier NNF, and El Hadi AF wrote the original draft, and reviewed and edited the manuscript; All authors read and approved the final version of the manuscript to be published.

Institutional review board statement: This study was approved by the institutional review board of Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai with approval number MBRU IRB-2023-323, dated 25 January 2024.

Informed consent statement: The use of retrospective de-identified data in the study resulted in the waiver of written informed consent from patients. The consent waiver was approved by the institutional review board.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: Deidentified data and study materials are available upon reasonable request from the corresponding author at bhushansudhakar2018@gmail.com

Corresponding author: Bhushan Sudhakar Wankhade, MD, Surgical Intensive Care, Rashid Hospital, Oud Metha, Dubai 7272, United Arab Emirates. bhushansudhakar2018@gmail.com

Received: May 29, 2025
Revised: June 20, 2025
Accepted: September 17, 2025
Published online: December 9, 2025
Processing time: 184 Days and 3 Hours

Abstract

BACKGROUND

Traumatic brain injury (TBI) is the second most common presentation of trauma victims. Among the various non-neurological complications after TBI, acute kidney injury (AKI) is not uncommon.

AIM

To establish the incidence, risk factors, and predictors of AKI in TBI victims. The secondary aim was to study the impact of AKI development on the outcomes of patients with TBI.

METHODS

This was a single-center retrospective cohort study of TBI victims with a Glasgow coma scale (GCS) ≤ 11 in an apex trauma center in a metropolitan city.

RESULTS

The incidence of AKI after TBI was 11%. The risk factors for AKI after TBI were old age (P < 0.001), comorbidities (P = 0.023), shock (P < 0.001), blood transfusion (P = 0.016), consecutive neurosurgical intervention (P = 0.029), high intracranial pressure (ICP) (P < 0.001), rhabdomyolysis (P < 0.001), and diabetes insipidus (P < 0.001). The predictors of AKI after TBI were, on point-biserial correlation: Lower GCS (r_pb = -0.27, n = 331, P < 0.001); and on multivariate logistic regression: (1) Shock (odds ratio [OR]: -11.94, P < 0.001); (2) Rhabdomyolysis (OR: -7.33, P = 0.001); (3) High ICP (OR: -4.39, P = 0.018); (4) High Carlson comorbidity index (OR: -1.97, P = 0.001); and (5) High acute physiology and chronic health evaluation-2 (APACHE-2) score (OR: -1.13, P < 0.001). The phenomenon of post-TBI AKI increased the extent of stay in intensive care unit (P = 0.008), demand for ventilators (P = 0.0170), ventilator days (P < 0.001), incidence of brain death (P < 0.001), and mortality (P < 0.001).

CONCLUSION

Every tenth TBI victim suffers from AKI. AKI after TBI can be predicted by the patient's underlying comorbidities, on arrival low GCS, high APACHE-2 score, shock, rhabdomyolysis, and high ICP. The occurrence of AKI in TBI victims adversely affects outcome variables; however, this may be a reflection of the severe nature of TBI in the AKI group. New research is needed to understand the effects of AKI on outcome variables.

Keywords: Traumatic brain injury; Acute kidney injury; Glasgow coma scale; Injury Severity Score; Brain death

Core Tip: After traumatic brain injury (TBI), patients are prone to develop non-neurological complications. Intensivists play a vital role in managing patients with TBI and preventing non-neurological complications. Among various non-neurological complications after TBI, acute kidney injury (AKI) is not uncommon and can negatively affect the patient's outcome. The incidence, risk factors, and predictors of AKI events in patients with TBI are further revealed by this study. In general, the severity of injury is the main determinant of both the development of AKI and the patient's outcome after TBI.