ACUTE-RENAL-FAILURE IN POLYTRAUMATIZED PATIENTS - PREDICTION OF OUTCOME

Prediction of outcome of acute renal failure (ARF), particularly in pa tients with multisystem organ failure (MSOF), is a very important issu e and a very difficult task. In patients with ARF as a consequence of severe polytrauma, frequent complications (e.g., sepsis, respiratory i nsufficiency, DIC, hepatic insufficiency, etc.) contribute to a hyperb olic state, and in the case of synergistic action, they start the mech anism of MSOF: In 33 patients (1 female, 32 male, 38.61 +/- 8.79 years ) with severe polytrauma acquired in war combat, ARF developed requiri ng hemodialysis (HD) treatment. Seventeen out of 33 (51.4%) recovered renal function. In 12 out of 33 patients, MSOF occurred with less succ essful recovery results. The analysis of pathophysiologic mechanisms o f MSOF appearance and ARF outcome has shown the importance of blast in juries, bowel injury, respiratory insufficiency requiring assisted ven tilation, and sepsis. Although severe hemorrhage and shock are the com mon mechanism of ARF appearance in these patients, it seems that wound s by themselves can be of great importance, as abdominal wounds pre mo re frequently associated with ARF and MSOF than in other types.