ArticleNeurocritical care2026
Serum-Creatinine-Estimated Augmented Renal Clearance is Associated with Marked Weight Loss after Severe Traumatic Brain Injury.
Article in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND/
objectiveAugmented renal clearance is commonly evaluated as a pharmacokinetic problem in critically ill trauma patients. In severe traumatic brain injury (TBI), increased serum-creatinine-estimated creatinine clearance may also reflect a broader hyperdynamic or metabolically vulnerable phenotype. We aimed to characterize the incidence and clinical profile of serum-creatinine-estimated augmented renal clearance (eARC) after severe TBI and to examine its association with day-28 body weight loss.
methodsWe performed a retrospective observational cohort study of intensive care unit (ICU) admissions of adults with severe traumatic brain injury (TBI) at a tertiary academic level I trauma center between 2015 and 2024. Because measured urinary creatinine clearance was not systematically available, serum-creatinine-estimated augmented renal clearance (eARC) was defined as estimated creatinine clearance (eCrCl) ≥ 130 mL/min/1.73 m
resultsAmong 342 included admissions, eARC occurred in 197 patients (57.6%). Patients with eARC were younger, more often male, and had lower admission Glasgow Coma Scale (GCS) scores. Patients with eARC experienced greater day-28 body weight loss than non-eARC patients (median -12.7% vs. 0.0%; p < 0.001), and severe weight loss was more frequent in the eARC group. In exploratory multivariable analysis adjusted for age and admission GCS score, eARC remained associated with severe day-28 weight loss. After incorporating propofol-derived calories, total energy delivery was similar between eARC and non-eARC groups. Serum sodium, fluid input, urine output, and the input-minus-urine fluid balance estimate did not show clear group-level differences that explained the observed weight-loss difference.
conclusionsSerum-creatinine-estimated augmented renal clearance (ARC) was common after severe TBI and was associated with marked day-28 weight loss. These findings are hypothesis generating and suggest that eARC may identify a metabolically vulnerable subgroup, but prospective studies using measured creatinine clearance, detailed sodium-water balance assessment, and direct body composition measures are needed.
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