Impact of Blood Products on Acute Kidney Injury Complication in Spinal Fracture and Spinal Cord Injury Patients

Introduction: Acute Kidney Injury (AKI) is a complication among trauma patients, especially those with spinal cord injuries (SCI). This study explores the relationship between blood product transfusion and AKI development, hypothesizing that larger volumes of transfusions increase AKI risk in SCI patients.

Methods: Data from the National Trauma Databank (NTD) were analyzed. Inclusion criteria were patients with SCI who received transfusion of blood products during admission: packed red blood cells (PRBC), platelets, plasma, and cryoprecipitate. Blood product administration was categorized by units transfused using common volumes (e.g., PRBC: 2 units = 800 mL, >10 units = >3000 mL). Logistic regression assessed AKI risk, adjusting for systolic blood pressure (SBP), age, injury severity score (ISS), comorbidity index (CCI), highest injury level, and SCI presence. "No blood products" served as the control for each group.

Results: A total of 964,652 spinal fracture and SCI NTD cases were analyzed. Of these 94,981 SCI cases received blood products, and 1289 of these developed AKI. The regression analysis revealed a dose-dependent association between blood product transfusion and AKI risk. PRBC transfusions showed significant AKI odds, with 2 units associated with an OR of 1.84 (p < 0.001) and >10 units yielding an OR of 1.51 (p < 0.001). Platelets also increased AKI risk significantly; 3 units raised the odds to OR 2.10 (p < 0.001). Plasma transfusions had a notable effect, with >4 units associated with OR 2.18 (p < 0.001). In contrast, >3 units of cryoprecipitate correlated with a reduced AKI risk (OR 0.27, p < 0.001). Other significant predictors included SBP (OR 0.999, p < 0.001), age (OR 1.02, p < 0.001), ISS (OR 1.05, p < 0.001), CCI (OR 1.21, p < 0.001), and SCI (OR 1.24, p < 0.001).

Conclusion : Increasing volumes of PRBC, platelets, and plasma are associated with AKI in SCI patients. The underlying etiology of AKI in patients with SCI may be from hypotension or from blood product administration. Further work is required to investigate the underlying physiologic mechanisms.