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Risk factors for acute renal failure in trauma patients
G Vivino1, M Antonelli, M L Moro
1Istituto di Anestesiologia e Rianimazione, Università La Sapienza, Policlinico Umberto I, Rome, Italy.
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/l, 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/l, 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.