title: Predictors of pulmonary failure following severe trauma: a trauma registry-based analysis.
abstract: BACKGROUND
  The incidence of pulmonary failure in trauma patients is considered to be influenced by several factors such as liver injury. We intended to assess the association of various potential predictors of pulmonary failure following thoracic trauma and liver injury.
  
  
  METHODS
  Records of 12,585 trauma patients documented in the TraumaRegister DGU® of the German Trauma Society were analyzed regarding the potential impact of concomitant liver injury on the incidence of pulmonary failure using uni- and multivariate analyses. Pulmonary failure was defined as pulmonary failure of ≥ 3 SOFA-score points for at least two days. Patients were subdivided according to their injury pattern into four groups: group 1: AIS thorax < 3; AIS liver < 3; group 2: AIS thorax ≥ 3; AIS liver < 3; group 3: AIS thorax < 3; AIS liver ≥ 3 and group 4: AIS thorax ≥ 3; AIS liver ≥ 3.
  
  
  RESULTS
  Overall, 2643 (21%) developed pulmonary failure, 12% (n= 642) in group 1, 26% (n= 697) in group 2, 16% (n= 30) in group 3, and 36% (n= 188) in group 4. Factors independently associated with pulmonary failure included relevant lung injury, pre-existing medical conditions (PMC), sex, transfusion of more than 10 units of packed red blood cells (PRBC), Glasgow Coma Scale (GCS) ≤ 8, and the ISS. However, liver injury was not associated with an increased risk of pulmonary failure following severe trauma in our setting.
  
  
  CONCLUSIONS
  Specific factors, but not liver injury, were associated with an increased risk of pulmonary failure following trauma. Trauma surgeons should be aware of these factors for optimized intensive care treatment.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Frankfurt am Main, D-60590, Germany. Emanuel.Geiger@kgu.de
authors.forename: Emanuel V
authors.initials: EV
authors.lastname: Geiger
authors.forename: Thomas
authors.initials: T
authors.lastname: Lustenberger
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wutzler
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Mark
authors.initials: M
authors.lastname: Lehnert
authors.forename: Felix
authors.initials: F
authors.lastname: Walcher
authors.forename: Helmut L
authors.initials: HL
authors.lastname: Laurer
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
mesh_terms: D000328:Adult; D005260:Female; D005858:Germany; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000453:epidemiology; D015999:Multivariate Analysis; D012042:Registries; D012131:Respiratory Insufficiency / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult