Spinal cord injury is an independent risk factor for acute kidney injury in traumatic spine-injured patients in the National Trauma Data Bank

Patients with spine injuries are at risk of acute kidney injury (AKI) through several mechanisms. This study aims to assess the rate of severe AKI in a nationally representative sample of patients with spine injuries and determine whether SCI is an independent risk factor. We conducted a cohort study utilizing the National Trauma Databank (NTDB) Patients included were 18 years or older with cervical or thoracic spine injuries (spine fractures and/or spinal cord injury) based on International Classification of Disease (ICD) codes from 2017 to 2022. Patients with pre-existing renal impairment were excluded. Logistic regression was used to determine the association between demographic and injury variables with incident AKI. 313,838 spinal injury patients were analyzed, of which 3,288 (1.05%) developed AKI. Patients with AKI were older (61 ± 19 vs. 55 ± 21 years, P < 0.001) and had more comorbidities. AKI was associated with higher Injury Severity Scores (23 ± 16 vs. 16 ± 12, P < 0.001) and increased blood product transfusions. After adjustment for confounders, SCI was independently associated with AKI (OR 1.41, 95% CI 1.28-1.55, P < 0.001). AKI patients experienced worse outcomes, including longer ICU stays, higher rates of withdrawal of care and unfavorable hospital dispositions (all P < 0.001). AKI is associated with morbidity and mortality in patients with spine injuries. Comorbidities and more severe injuries, including the presence of SCI, are associated with AKI. More work is warranted to understand mechanisms of AKI in these patients.