One-year mortality associations in hemodialysis patients after traumatic brain injury--an eight-year population-based study.
OBJECTIVE
This study aimed to investigate the one-year mortality associations in hemodialysis patients who underwent neurosurgical intervention after traumatic brain injury (TBI) using a nationwide database in Taiwan.


METHODS
An age- and gender-matched longitudinal cohort study of 4416 subjects, 1104 TBI patients with end-stage renal disease (ESRD) and 3312 TBI patients without ESRD, was conducted using the National Health Insurance Research Database in Taiwan between January 2000 and December 2007. The demographic characteristics, length of stay (LOS), length of ICU stay, length of ventilation (LOV), and tracheostomy were collected and analyzed. The co-morbidities of hypertension (HTN), diabetes mellitus (DM), myocardial infarction (MI), stroke, and heart failure (HF) were also evaluated.


RESULTS
TBI patients with ESRD presented a shorter LOS, a longer length of ICU stay and LOV, and a higher percentage of comorbidities compared with those without ESRD. TBI patients with ESRD displayed a stable trend of one-year mortality rate, 75.82% to 76.79%, from 2000-2007. For TBI patients with ESRD, the median survival time was 0.86 months, and pre-existing stroke was a significant risk factor of mortality (HR: 1.29, 95% C.I.: 1.08-1.55). Pre-existing DM (HR: 1.35, 95% C.I.: 1.12-1.63) and MI (HR: 1.61, 95% C.I.: 1.07-2.42) effect on the mortality in ESRD patients who underwent TBI surgical intervention in the younger (age<65) and older (age≥65) population, respectively. In addition, the length of ICU stay and tracheostomy may provide important information to predict the mortality risk.


CONCLUSIONS
This is the first report indicating an increased risk of one-year mortality among TBI patients with a pre-existing ERSD insult. Comorbidities were more common in TBI patients with ESRD. Physicians should pay more attention to TBI patients with ESRD based on the status of age, comorbidities, length of ICU stay, and tracheostomy to improve their survival.
Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
Jen-Chieh
JC
Liao
Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Chung-Han
CH
Ho
Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Fu-Wen
FW
Liang
Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
Jhi-Joung
JJ
Wang
Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
Kao-Chang
KC
Lin
Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
Chung-Ching
CC
Chio
Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
Jinn-Rung
JR
Kuo
D000368:Aged; D001930:Brain Injuries / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality*; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000401:mortality*; D012306:Risk; D013624:Taiwan / Q000453:epidemiology