Incidence of, Risk Factors for, and Mortality Associated With Severe Acute Kidney Injury After Gunshot Wound
Authors: Ambarish M. Athavale, Chih-Yuan Fu, Faran Bokhari, Francesco Bajani, Peter Hart
Journal: JAMA Network Open (2019)

<h3>Importance</h3> Acute kidney injury increases the risk of mortality in hospitalized patients. However, incidence of severe acute kidney injury (SAKI) and its association with mortality in civilians with gunshot wounds (GSWs) is not known. <h3>Objective</h3> To determine the incidence of and risk factors associated with SAKI and acute kidney injury requiring dialysis (AKI-D) after GSWs and the association of SAKI and AKI-D with mortality among civilians in the United States. <h3>Design, Setting, and Participants</h3> This retrospective cross-sectional study included civilians with GSW reported to the National Trauma Data Bank between July 1, 2010, and June 30, 2015. Torso GSWs were included in study; GSWs to the head were excluded. The data were analyzed between September and November 2018. <h3>Exposure</h3> Civilians with GSW. <h3>Main Outcomes and Measures</h3> Incidence of SAKI and AKI-D; association of SAKI and AKI-D with mortality. <h3>Results</h3> Most of the 64 059 civilian GSWs affected men (57 431 [89.7%]) and racial/ethnic minorities (36 205 [56.5%] African American individuals; 9681 [15.1%] Hispanic individuals). Incidence of SAKI was 2.3% (1450 of 64 059), and incidence of AKI-D was 0.9% (588 of 64 059). On multivariate analysis, SAKI was associated with older age (odds ratio [OR], 1.02; 95% CI, 1.01-1.02;<i>P</i> &lt; .001), male sex (OR, 1.37; 95% CI, 1.12-1.66;<i>P</i> = .002), diabetes (OR, 1.55; 95% CI, 1.20-2.00;<i>P</i> = .001), hypertension (OR, 1.76; 95% CI, 1.46-2.11;<i>P</i> &lt; .001), Glasgow Coma Scale score (OR, 0.98; 95% CI, 0.96-0.99;<i>P</i> = .002), sepsis (OR, 13.83; 95% CI, 11.77-16.24;<i>P</i> &lt; .001), hollow viscus injury (OR, 2.31; 95% CI, 2.05-2.59;<i>P</i> &lt; .001), and injury severity score (OR, 1.02; 95% CI, 1.01-1.02;<i>P</i> &lt; .001); AKI-D was associated with systolic blood pressure (OR, 0.99; 95% CI, 0.99-1.00;<i>P</i> &lt; .001), sepsis (OR, 1.56; 95% CI, 1.18-2.04;<i>P</i> = .001), and injury severity score (OR, 1.01; 95% CI, 1.01-1.02;<i>P</i> = .001). Mortality was significantly higher in patients with AKI-D (167 of 588 patients [28.4%]) compared with patients with SAKI (172 of 862 [20.0%]) and no SAKI or AKI-D (5521 of 62 609 [8.8%]) (<i>P</i> &lt; .001). Mortality was associated with older age (OR, 1.01; 95% CI, 1.01-1.01;<i>P</i> &lt; .001), systolic blood pressure (OR, 0.997; 95% CI, 0.997-0.998;<i>P</i> &lt; .001), Glasgow Coma Scale score (OR, 0.87; 95% CI, 0.87-0.88;<i>P</i> &lt; .001), SAKI (OR, 2.32; 95% CI, 1.93-2.79;<i>P</i> &lt; .001), AKI-D (OR, 1.46; 95% CI, 1.12-1.90;<i>P</i> &lt; .001), hollow viscus injury (OR, 1.87; 95% CI, 1.76-1.98;<i>P</i> &lt; .001), and higher injury severity score (OR, 1.01; 95% CI, 1.01-1.01;<i>P</i> &lt; .001). After matching for variables except SAKI or AKI-D, patients with SAKI were twice as likely to die than patients without SAKI (320 of 1391 [23.0%] vs 158 of 1391 [11.4%];<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> In this cross-sectional study, SAKI among civilians who experienced GSWs was associated with mortality.