ACUTE-RENAL-FAILURE IN PATIENTS WITH SEVERE CIVILIAN TRAUMA

We reviewed our experience with patients suffering from civilian traum a to identify risk factors for the development of acute renal failure (ARF) and ARF outcome. Of the 437 patients consecutively admitted to a surgical intensive care unit (SICU), 206 had a SICU stay of at least 1 day and ARF developed in 30 of these patients. All ARF patients had additional organ system failure (OSF). Pre-existing chronic disease (i ncluding chronic renal failure), malnutrition, injury severity score ( ISS), number of organs injured, sepsis, and all OSFs before the onset of ARF were factors predisposing to ARF. Mortality was 40%. Chronic di sease, malnutrition, ISS, failure of cardiovascular, pulmonary, hepati c, and neurological systems (either before and after ARF) were signifi cantly associated with mortality. When OSFs were considered in their t emporal relationships to ARF, only cardiovascular and pulmonary failur e before, and gastrointestinal failure after, the onset of ARF were re lated to mortality. An increasing number of OSFs increased mortality, both before and after the development of ARF. However, the number of O SFs before was significantly greater than after ARF. Sepsis was not as sociated with increased mortality. Thus, the outcome of ARF patients w ith critical trauma seems to be dependent on factors predisposing to A RF. Our results suggest that more attention must be paid to prevention of these precipitating conditions.