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 observationa l study. Setting: A general intensive care unit (ICU) of a university hospital. Patients: A cohort of 153 consecutive trauma patients admitt ed to the ICU over a period of 30 months. Results: Forty-eight (31 %) patients developed ARE They were older than the 105 patients without A RF (p = 0.002), had a higher Injury Severity Score (ISS) (p < 0.001), higher mortality (p < 0.001), a more compromised neurological conditio n (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 a ge, ISS > 17, the presence of hemoperitoneum, shock, hypotension, or b one fractures, rhabdomyolysis with creatine phosphokinase (CPK) > 10 0 00 IU/l, presence of acute lung injury requiring mechanical ventilatio n, and Glasgow Coma Score < 10. Sepsis and use of nephrotoxic agents w ere not associated with an increased risk of ARE In the logistic model , the need for mechanical ventilation with a positive end-expiratory p ressure > 6 cm H2O, rhabdomyolysis with CPK > 10 000 IU/l: and hemoper itoneum were the three conditions most strongly associated with ARF.Co nclusions: The identified risk factors for post-traumatic acute renal failure may help the provision of future strategies.