Association between anemia and trauma-related severe acute kidney injury in trauma patients at risk of major bleeding: A post-hoc analysis of the RESTRIC trial

IF 2.9 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2026-04-01 Epub Date: 2025-11-24 DOI:10.1016/j.jcrc.2025.155364

Yuko Okishio , Kyohei Miyamoto , Tsuyoshi Nakashima , Mineji Hayakawa , Daisuke Kudo , Shigeki Kushimoto , Takashi Tagami , Kosei Kunitatsu , Shuji Kawashima , Kentaro Ueda , Shigeaki Inoue

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引用次数: 0

Abstract

Purpose

Trauma-related acute kidney injury (AKI) is associated with increased mortality. Anemia on admission has been reported as a risk factor for AKI in non-trauma patients. Several studies have reported an association between anemia and trauma-related AKI. However, very few studies specifically focused on the association between anemia at emergency department (ED) admission and trauma-related severe AKI. We aimed to investigate this association in this post-hoc analysis.

Materials and methods

We retrospectively analyzed the dataset of the Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial, a cluster-randomized, crossover, non-inferiority multicenter study that included 422 trauma patients at risk of major bleeding to compare restrictive and liberal transfusion strategies. Patients undergoing chronic hemodialysis were excluded. We assessed the association between anemia at ED admission (hemoglobin <10 g/dL) and trauma-related severe AKI defined as Kidney Disease: Improving Global Outcomes Stage 3, occurring within 7 days of admission. A multivariate logistic regression model was employed to adjust for propensity scores predicting the likelihood of anemia at ED admission, calculated from predefined risk factors relevant to trauma-related severe AKI and randomized allocations (e.g., transfusion strategies).

Results

Trauma-related severe AKI occurred in 15 (3.6 %) of the final study population of 417 patients. Of all patients, 63 (15 %) presented with anemia at ED admission. The multivariate logistic regression model revealed a significant association between anemia at ED admission and trauma-related severe AKI (adjusted odds ratio 3.9, 95 % confidence interval 1.2–12.9, p = 0.029).

Conclusions

Anemia at ED admission might be associated with trauma-related AKI in trauma patients at risk of major bleeding.

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在有大出血风险的创伤患者中，贫血与创伤相关的严重急性肾损伤之间的关系：一项对restrict试验的事后分析

目的：外伤性急性肾损伤（AKI）与死亡率升高相关。入院时贫血已被报道为非创伤患者AKI的危险因素。一些研究报道了贫血与创伤性AKI之间的联系。然而，很少有研究专门关注急诊科（ED）入院时贫血与创伤相关的严重AKI之间的关系。我们的目的是在这个事后分析中调查这种关联。材料和方法：我们回顾性分析了重伤员限制性红细胞输血策略（restrc）试验的数据集，这是一项包括422名有大出血风险的创伤患者的聚类随机、交叉、非劣效性多中心研究，以比较限制性和自由输血策略。排除慢性血液透析患者。我们评估了急诊入院时贫血与血红蛋白之间的关系。结果：在417例最终研究人群中，有15例（3.6%）发生了创伤相关的严重AKI。在所有患者中，63例（15%）在急诊科入院时出现贫血。多因素logistic回归模型显示急诊科入院时贫血与创伤相关严重AKI之间存在显著关联（校正优势比为3.9,95%可信区间为1.2-12.9,p = 0.029）。结论：急诊入院时贫血可能与有大出血风险的创伤性AKI相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.