Risk factors for acute renal failure in trauma patients
- 259 Downloads
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
Unable to display preview. Download preview PDF.
- 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.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
- 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
- 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.Knöchel JP (1981) Rhabdomyolysis and myoglobinuria. Semin Nephrol 1: 75Google Scholar
- 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
- 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
- 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
- 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