Glomerular permeability and trauma: A correlation between microalbuminuriaand injury severity score

Objective: To determine if there is a correlation between an increase in gl omerular permeability, the magnitude of trauma, and the severity of illness . Design: Prospective study. Setting: Two university hospital intensive care units. Patients: Forty consecutive critically ill trauma patients admitted directl y to the intensive care unit within 120 mins of their injuries. Interventions: None. Measurements and Main Results:For each patient, urine was collected from th e time of admission until 7 am the next day. Within 48 hrs, only one sample of all urine collected (5 mt) was examined for microalbuminuria and urinar y creatinine. Results were expressed as the microalbuminuria/urinary creati nine ratio (MACR). The mortality rate in the intensive care unit, Injury Se verity Score at the moment of admission, Acute Physiology and Chronic Healt h Evaluation III score, and Simplified Acute Physiology Score in the first 24 hrs were calculated for each patient. The data were analyzed using the P earson test for linear regression and Student's t-test. During the first 24 hrs after trauma, there was an increase of MACR (6.9 +/- 0.6 mg/mmol) abov e normal (reference range, <3 mg/mmol) that was positively correlated with Injury Severity Score (31.4 +/- 1.9; r(2) = .73, p < .05). However, there w as no correlation between MACR, Acute Physiology and Chronic Health Evaluat ion ill score, Simplified Acute Physiology Score, and mortality rate. Conclusions: Patients with trauma show an increase in glomerular permeabili ty during the first 24 hrs after injury. The magnitude of this increase is correlated with the extent of trauma but does not seem significant enough t o be predictive of severity of illness and/or outcome.