Natural History and Outcomes of Renal Failure after Trauma

Carlos V R Brown, Joseph J. Dubose, Pantelis Hadjizacharia, Hakan Yanar, Ali Salim, Kenji Inaba, Peter M Rhee, Linda Chan, Demetrios Demetriades

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

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 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.

Original languageEnglish (US)
Pages (from-to)426-431
Number of pages6
JournalJournal of the American College of Surgeons
Volume206
Issue number3
DOIs
StatePublished - Mar 2008
Externally publishedYes

Fingerprint

Natural History
Renal Insufficiency
Wounds and Injuries
Creatinine
Dialysis
Serum
Registries
Mortality
Los Angeles
Craniocerebral Trauma
Laparotomy
Population
Renal Dialysis
Databases
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Brown, C. V. R., Dubose, J. J., Hadjizacharia, P., Yanar, H., Salim, A., Inaba, K., ... Demetriades, D. (2008). Natural History and Outcomes of Renal Failure after Trauma. Journal of the American College of Surgeons, 206(3), 426-431. https://doi.org/10.1016/j.jamcollsurg.2007.09.011

Natural History and Outcomes of Renal Failure after Trauma. / Brown, Carlos V R; Dubose, Joseph J.; Hadjizacharia, Pantelis; Yanar, Hakan; Salim, Ali; Inaba, Kenji; Rhee, Peter M; Chan, Linda; Demetriades, Demetrios.

In: Journal of the American College of Surgeons, Vol. 206, No. 3, 03.2008, p. 426-431.

Research output: Contribution to journalArticle

Brown, CVR, Dubose, JJ, Hadjizacharia, P, Yanar, H, Salim, A, Inaba, K, Rhee, PM, Chan, L & Demetriades, D 2008, 'Natural History and Outcomes of Renal Failure after Trauma', Journal of the American College of Surgeons, vol. 206, no. 3, pp. 426-431. https://doi.org/10.1016/j.jamcollsurg.2007.09.011
Brown CVR, Dubose JJ, Hadjizacharia P, Yanar H, Salim A, Inaba K et al. Natural History and Outcomes of Renal Failure after Trauma. Journal of the American College of Surgeons. 2008 Mar;206(3):426-431. https://doi.org/10.1016/j.jamcollsurg.2007.09.011
Brown, Carlos V R ; Dubose, Joseph J. ; Hadjizacharia, Pantelis ; Yanar, Hakan ; Salim, Ali ; Inaba, Kenji ; Rhee, Peter M ; Chan, Linda ; Demetriades, Demetrios. / Natural History and Outcomes of Renal Failure after Trauma. In: Journal of the American College of Surgeons. 2008 ; Vol. 206, No. 3. pp. 426-431.
@article{99e87d82c9f54fb88f01640fd62f7bf2,
title = "Natural History and Outcomes of Renal Failure after Trauma",
abstract = "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 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.",
author = "Brown, {Carlos V R} and Dubose, {Joseph J.} and Pantelis Hadjizacharia and Hakan Yanar and Ali Salim and Kenji Inaba and Rhee, {Peter M} and Linda Chan and Demetrios Demetriades",
year = "2008",
month = "3",
doi = "10.1016/j.jamcollsurg.2007.09.011",
language = "English (US)",
volume = "206",
pages = "426--431",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Natural History and Outcomes of Renal Failure after Trauma

AU - Brown, Carlos V R

AU - Dubose, Joseph J.

AU - Hadjizacharia, Pantelis

AU - Yanar, Hakan

AU - Salim, Ali

AU - Inaba, Kenji

AU - Rhee, Peter M

AU - Chan, Linda

AU - Demetriades, Demetrios

PY - 2008/3

Y1 - 2008/3

N2 - 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 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.

AB - 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 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.

UR - http://www.scopus.com/inward/record.url?scp=39549120642&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=39549120642&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2007.09.011

DO - 10.1016/j.jamcollsurg.2007.09.011

M3 - Article

C2 - 18308211

AN - SCOPUS:39549120642

VL - 206

SP - 426

EP - 431

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 3

ER -