Risk factors for acute renal failure in trauma patients.

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.