Acute kidney injury after hip fracture surgery among elderly patients in the ICU: incidence, risk factors and their predictive value, clinical impact—a retrospective single-center study

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Abstract
To explore the incidence, risk factors and clinical effects of acute kidney injury (AKI) in elderly patients with hip fracture admitted to the ICU postoperatively and assess the predictive value of risk factors. We retrospectively analyzed consecutive elderly patients with hip fracture who underwent surgery and were admitted to the ICU at Beijing Jishuitan Hospital, Capital Medical University (October 2022-August 2023). Patients were divided into AKI group and non-AKI group according to whether AKI occurred. Demographic, preoperative, intraoperative, and postoperative data were compared. Multivariate logistic regression identified AKI risk factors, and receiver operating characteristic (ROC) curves evaluated their predictive ability. Among 156 patients, 31 (19.9%) developed AKI. Multivariate logistic regression analysis showed that female sex, intraoperative blood transfusion, postoperative albumin level and postoperative Acute Physiology and Chronic Health Evaluation (APACHE) II score were independent risk factors for AKI (p < 0.05). ROC curve showed that the combination of these four indicators and postoperative APACHE II score could effectively predict AKI occurrence, and the area under the curve (AUC) was 0.93 and 0.86, respectively (p < 0.05). Patients in the AKI group stayed in ICU longer than those in the non-AKI group (p < 0.05). The incidence of AKI was high in elderly patients with hip fracture admitted to ICU after surgery. The combination of being female, receipt of intraoperative blood transfusion, postoperative albumin level and postoperative APACHE II score had good predictive value for AKI. The occurrence of AKI resulted in prolonged ICU stay.

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