Natural history and outcomes of renal failure after trauma.
BACKGROUND
The natural history of posttraumatic renal failure (PTRF) is not well-established. Overall prognosis and risk factors for need for dialysis in the setting of PTRF need more precise definition.


METHODS
We conducted a retrospective review of the trauma registry information from Los Angeles County-University of Southern California Medical Center from 1998 through 2005. PTRF was defined as the occurrence of serum creatinine > or = 2 mg/dL after admission for trauma. Clinical course and laboratory information from the trauma registry and ICU databases were analyzed.


RESULTS
Of 33,376 trauma patients identified, PTRF developed in 323 (1%), with an overall mortality of 38% (n = 120). Onset of PTRF occurred an average of 4 +/- 7 days after admission, with average peak serum creatinine occurring 7 +/- 1 days after admission and only 56% (n = 180) of patients normalizing serum creatinine before discharge. A total of 64 patients (20% of renal failure patients, 0.2% of all trauma patients) required hemodialysis. The only independent risk factor for the need for dialysis was laparotomy, with patients manifesting an elevated creatinine later in their course more likely to require dialysis. Although injury severity correlated well with outcomes, the only independent risk factors for mortality in this population were persistently elevated serum creatinine and head Abbreviated Injury Score > 3.


CONCLUSIONS
Development of PTRF in severely injured patients represents a substantial risk for morbidity and mortality in this population. Additional study is needed to determine the importance of delayed onset of PTRF, particularly in the setting of multiorgan failure, in determining outcomes.
Brown
Carlos V R
CV
Department of Surgery, Brackenridge Hospital, University of Texas Medical Branch-Austin, Austin, TX 78701, USA.
Dubose
Joseph J
JJ
Hadjizacharia
Pantelis
P
Yanar
Hakan
H
Salim
Ali
A
Inaba
Kenji
K
Rhee
Peter
P
Chan
Linda
L
Demetriades
Demetrios
D
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications*