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Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients
Author(s) -
AlaKokko T.,
Ohtonen P.,
Laurila J.,
Martikainen M.,
Kaukoranta P.
Publication year - 2006
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2006.01082.x
Subject(s) - medicine , intensive care unit , apache ii , odds ratio , univariate analysis , confidence interval , population , intensive care , logistic regression , emergency medicine , intensive care medicine , multivariate analysis , environmental health
Background: Although multiple organ failure is the leading late cause of death, there is controversy about the impact of acute organ dysfunction and failure on trauma survival. Methods: Consecutive adult trauma admissions between January 2000 and June 2003, excluding isolated head traumas and burns, were analysed for parameters of organ function during the first 24 h following intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) scoring system. A national prospectively collected ICU data registry was used for analysis, including data from 22 ICUs in university and central hospitals in Finland. Results: The study population consisted of 1044 eligible trauma admissions; 32% of the cases were treated at university hospital level, the rest being secondary referral central hospital admissions. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15 (SD8), ICU mortality was 5.6% and a further 1.6% of patients died during their post‐ICU hospital stay. Forty‐five per cent of the patients were categorized as having multiple traumas. In univariate analysis, APACHE II ≥ 25 [odds ratio (OR), 35; 95% confidence interval (CI), 18–66] and renal failure (OR, 29.5; 95% CI, 14–63) produced the highest ORs for ICU mortality. In the APACHE II‐, sex‐ and age‐adjusted logistic regression model, renal failure was a significant risk factor for both ICU and hospital mortality (OR, 11.8; 95% CI, 3.9–35.4; OR, 8.2; 95% CI, 2.9–23.2, respectively). Conclusion: The development of renal failure during the initial 24 h of ICU stay remained an independent risk factor for mortality in trauma patients requiring intensive care treatment even after adjusting for the APACHE II score, age and sex.