Risk factors for acute renal failure in trauma patients

Intensive Care Med. 1998 Aug;24(8):808-14. doi: 10.1007/s001340050670.

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/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.

MeSH terms

  • Acute Kidney Injury / etiology*
  • Adult
  • Age Factors
  • Female
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Male
  • Middle Aged
  • Multiple Trauma / complications*
  • Prospective Studies
  • Respiration, Artificial
  • Rhabdomyolysis / complications
  • Risk Factors
  • Shock / complications
  • Statistics as Topic
  • Trauma Severity Indices