Natural history and outcomes of renal failure after trauma
Natural history and outcomes of renal failure after trauma
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DOI：
10.1016/j.jamcollsurg.2007.09.011
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发表时间：
2008-03-01
影响因子：
5.2
通讯作者：
Demetriades, Demetrios
中科院分区：
文献类型：
--
作者：
Brown, Carlos V. R.;Dubose, Joseph J.;Demetriades, Demetrios
背景：创伤后肾功能衰竭（PTRF）的自然史尚未明确。总体预后和风险因素需要透析的设置PTRF.Study设计：我们进行了一项回顾性研究，从1998年至2005年的创伤登记信息从洛杉矶县南加州大学医学中心。PTRF定义为创伤入院后血清肌酐≥ 2 mg/dL。临床过程和实验室信息从创伤注册和ICU databases.Results：33，376创伤患者确定，PTRF开发323（1%），总死亡率为38%（n=120）。PTRF的发作平均发生在入院后4 ± 7天，平均峰值血清肌酐发生在入院后7 ± 1天，只有56%（n=180）的患者在出院前血清肌酐正常化。共有64例患者（20%的肾衰竭患者，0.2%的所有创伤患者）需要血液透析。需要透析的唯一独立风险因素是Laparctomy，患者在病程后期出现肌酐升高更可能需要透析。虽然创伤严重程度与预后相关性很好，但在这一人群中死亡率的唯一独立危险因素是持续升高的血清肌酐和头部简明损伤评分> 3。结论：严重创伤患者发生PTRF是这一人群发病率和死亡率的重要风险。需要进一步的研究来确定PTRF延迟发作的重要性，特别是在多器官功能衰竭的情况下，在确定结果方面。
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.STUDY DESIGN: 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 >= 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 laparctomy, 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.