Natural history and outcomes of renal failure after trauma

The natural history of posttraumatic renal failure (PTRF) is not well-established. Overall prognosis and risk factors for need for dialysis in the setting of PTRF need more precise definition.

We conducted a retrospective review of the trauma registry information from Los Angeles County-University of Southern California Medical Center from 1998 through 2005. PTRF was defined as the occurrence of serum creatinine > or = 2 mg/dL after admission for trauma. Clinical course and laboratory information from the trauma registry and ICU databases were analyzed.

Of 33,376 trauma patients identified, PTRF developed in 323 (1%), with an overall mortality of 38% (n = 120). Onset of PTRF occurred an average of 4 +/- 7 days after admission, with average peak serum creatinine occurring 7 +/- 1 days after admission and only 56% (n = 180) of patients normalizing serum creatinine before discharge. A total of 64 patients (20% of renal failure patients, 0.2% of all trauma patients) required hemodialysis. The only independent risk factor for the need for dialysis was laparotomy, with patients manifesting an elevated creatinine later in their course more likely to require dialysis. Although injury severity correlated well with outcomes, the only independent risk factors for mortality in this population were persistently elevated serum creatinine and head Abbreviated Injury Score > 3.

Development of PTRF in severely injured patients represents a substantial risk for morbidity and mortality in this population. Additional study is needed to determine the importance of delayed onset of PTRF, particularly in the setting of multiorgan failure, in determining outcomes.