Risk factors for acute renal failure in trauma patients
To elucidate the risk factors for the development of acute renal failure (ARF) in severe trauma.
Prospective observational study.
A general intensive care unit (ICU) of a university hospital.
A cohort of 153 consecutive trauma patients admitted to the ICU over a period of 30 months.
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.
The identified risk factors for post-traumatic acute renal failure may help the provision of future strategies.
Key wordsAcute renal failure Trauma Rhabdomiolysis Mechanical ventilation Hemoperitoneum
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