Advertisement

Intensive Care Medicine

, Volume 24, Issue 8, pp 808–814 | Cite as

Risk factors for acute renal failure in trauma patients

  • G. Vivino
  • M. AntonelliEmail author
  • M. L. Moro
  • F. Cottini
  • G. Conti
  • M. Bufi
  • F. Cannata
  • A. Gasparetto
Original

Abstract

Objective

To elucidate the risk factors for the development of acute renal failure (ARF) in severe trauma.

Design

Prospective observational study.

Setting

A general intensive care unit (ICU) of a university hospital.

Patients

A cohort of 153 consecutive trauma patients admitted to the ICU over a period of 30 months.

Results

Forty-eight (31 %) patients developed ARF. They were older than the 105 patients without ARF (p=0.002), had a higher Injury Severity Score (ISS) (p>0.001), higher mortality (p>0.001), a more compromised neurological condition (p=0.007), and their arterial pressure at study entry was lower (p=0.0015). In the univariate analysis, the risk of ARF increased by age, ISS>17, the presence of hemoperitoneum, shock, hypotension, or bone fractures, rhabdomyolysis with creatine Phosphokinase (CPK)>10000 IU/1, presence of acute lung injury requiring mechanical ventilation, and Glasgow Coma Score>10. Sepsis and use of nephrotoxic agents were not associated with an increased risk of ARF. In the logistic model, the need for mechanical ventilation with a positive end-expiratory pressure>6 cm H2O, rhabdomyolysis with CPK>10000 IU/1, and hemoperitoneum were the three conditions most strongly associated with ARF.

Conclusions

The identified risk factors for post-traumatic acute renal failure may help the provision of future strategies.

Key words

Acute renal failure Trauma Rhabdomiolysis Mechanical ventilation Hemoperitoneum 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Morris JA, Mucha P, Ross SE et al (1991) Acute posttraumatic renal failure: a multicenter perspective. J Trauma 31:1584–1590PubMedCrossRefGoogle Scholar
  2. 2.
    Regel G, Lobenhoffer P, Grotz M, Pape HC, Lahmann, Tscherne H (1995) Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at German level I trauma center. J Trauma 38: 70–77PubMedCrossRefGoogle Scholar
  3. 3.
    Morris JA, MacKenzie EJ, Edelstein SL (1990) The effect of preexisting conditions on mortality in trauma patients. JAMA 262:1942–1948CrossRefGoogle Scholar
  4. 4.
    Tran DD, Cuesta MA (1994) Acute renal failure in patients with severe civilian trauma. Nephrol Dial Transplant 9: 121–125PubMedGoogle Scholar
  5. 5.
    Letteri JM (1987) Post-traumatic acute renal failure. Adv Exp Med Biol 212: 211–218PubMedGoogle Scholar
  6. 6.
    Menashe PI, Ross SA, Gottlieb JE (1988) Acquired renal insufficiency in critically ill patients. Crit Care Med 16: 1106–1109PubMedCrossRefGoogle Scholar
  7. 7.
    Stene JK (1990) Renal failure in trauma patients. Crit Care Clin 6: 111PubMedGoogle Scholar
  8. 8.
    Thadani R, Pascual M, Bonventre JV (1996) Acute renal failure. N Engl J Med 30:1448–1459CrossRefGoogle Scholar
  9. 9.
    Mason JC, Joeris B, Welsch J, Kriz W (1989) Vascular congestion in ischemic renal failure: the role of cell swelling. Miner Electrolyte Metab 15:114–124PubMedGoogle Scholar
  10. 10.
    Vetterlein F, Petho A, Schmidt G (1986) Distribution of capillary blood flow in the rat kidney during postischemic renal failure. Am J Physiol 215: H510-H519Google Scholar
  11. 11.
    Meyer AA (1988) Acute renal failure. In: Wilmore DW, Brennan MF, Harken AH et al (eds) American College of Surgeons care of the surgical patients. Scientific American: 2.6: 1–12Google Scholar
  12. 12.
    Levy EM, Viscoli CM, Horwitz RI (1996) The effect of acute renal failure on mortality — a cohort analysis. JAMA 275:1489–1494PubMedCrossRefGoogle Scholar
  13. 13.
    Baker SP, O’Neill B, Haddon W et al (1988) The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196Google Scholar
  14. 14.
    Teasdale G, Jennet B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet II: 81–84CrossRefGoogle Scholar
  15. 15.
    Goris RJA, Boekhorst TPA, Niytink JKS, Gimbrere JFS (1985) Multiple organ failure: generalized autodestructive inflammation? Arch Surg 120: 1109–1114PubMedGoogle Scholar
  16. 16.
    Bernard GR, Artigas A, Brigham J, Carlet J, Falke K, Hudson M, Lamy M, LeGall R, Morris A, Spragg R, Consensus Committee (1994) The American-European consensus conference on ARDS. Am J Respir Crit Care Med 149: 818–824PubMedGoogle Scholar
  17. 17.
    Lucas EC, Ledgerwood AM (1991) Hemodynamic Management of the Injured. In: Capan LM, Miller SM, Turndorf H (eds) Trauma: anesthesia and intensive care. Lippincott, Philadelphia, pp 83–113Google Scholar
  18. 18.
    Knöchel JP (1981) Rhabdomyolysis and myoglobinuria. Semin Nephrol 1: 75Google Scholar
  19. 19.
    American College of Chest Physicians, Society of Critical Care Medicine (ACCP/SCCM) Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20: 864–874Google Scholar
  20. 20.
    Antonelli M, Moro ML, Capelli O, DeBlasi RA, D’Errico RR, Conti G, Bufi M, Gasparetto A (1994) Risk factors for early and late onset pneumonia in trauma patients. Chest 105: 224–228PubMedCrossRefGoogle Scholar
  21. 21.
    Antonelli M, Moro ML, D’Errico RR, Conti G, Bufi M, Gasparetto A (1996) Early and late onset bacteremia and different risk factors in trauma patients. Intensive Care Med 22: 735–741PubMedCrossRefGoogle Scholar
  22. 22.
    Novis BK, Roizen MF, Aroson S, Thisted RA (1994) Association of preoperative risk factors with postoperative acute renal failure. Anesth Analg 78: 143–149PubMedCrossRefGoogle Scholar
  23. 23.
    Groeneveld ABJ, Tran DD, Ven der Meulen J, Nauta JJP, Thijs JG (1991) Acute renal failure in the medical intensive care unit: predisposing, complicating factors and outcome. Nephron 59: 602–610PubMedCrossRefGoogle Scholar
  24. 24.
    Shustermann N, Strom BL, Murray TG (1987) The risk factors and outcome of hospital-acquired acute renal failure. Am J Med 83: 63–71Google Scholar
  25. 25.
    Hou SL, Bushinsky DA, Wish DB et al (1983) Hospital-acquired renal insufficiency: a prospective study. Am J Med 74: 243–248PubMedCrossRefGoogle Scholar
  26. 26.
    Harmann PK, Krön IL, McLachaln HD et al (1982) Elevated intra-abdominal pressure and renal function. Ann Surg 196: 594–597CrossRefGoogle Scholar
  27. 27.
    Antonelli M, Moro ML, Vivino G (1995) Bacteremia, pneumonia and acute renal failure in trauma patients. In Yearbook Intensive Care Emerg Med 834–842Google Scholar
  28. 28.
    Shinozaki M et al (1988) Hemodynamic relationship between renal venous pressure during positive and expiratory pressure. Crit Care Med 16:144–147PubMedCrossRefGoogle Scholar
  29. 29.
    Hock R, Anderson RJ (1995) Prevention of drug-induced nephrotoxicity in the intensive care unit. J Crit Care 10: 33–43PubMedCrossRefGoogle Scholar
  30. 30.
    Bellomo R, Ronco C (eds) (1996) Drug induced acute renal failure. In: Acute renal failure in the critically ill, Springer, Berlin Heidelberg New York, pp 183–213Google Scholar
  31. 31.
    Prins JM, Buller HR, Kuijper EJ et al (1993) Once versus thrice daily gentamicin in patient with serious infection. Lancet 341:335–339PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 1998

Authors and Affiliations

  • G. Vivino
    • 1
  • M. Antonelli
    • 1
    Email author
  • M. L. Moro
    • 2
  • F. Cottini
    • 1
  • G. Conti
    • 1
  • M. Bufi
    • 1
  • F. Cannata
    • 1
  • A. Gasparetto
    • 1
  1. 1.Istituto di Anestesiologia e RianimazioneUniversité La Sapienza, Policlinico Umberto IRomeItaly
  2. 2.Laboratorio di Epidemiologia e BiostatisticaIstituto Superiore di SanitàRomeItaly

Personalised recommendations