The risk factors for acute renal failure in patients undergoing emergency surgery for arterial vascular injury due to lower extremity trauma

Background: Acute renal failure is a common complication in trauma patients and can lead to significantly poorer outcomes. Although the prognosis has improved in recent decades, the mortality of acute renal failure remains considerable. In this study, we investigated the risk factors associated with acute renal failure in patients treated urgently for lower extremity arterial vascular injury.
Material-Methods: Between 2009 and 2019, 98 patients underwent surgical intervention for the diagnosis of arterial injury due to trauma to the lower extremity. We conducted a systematic literature search of studies on acute renal failure according to KDIGO (Kidney Disease Improving Global Outcomes), the most recently evolved scoring system incorporating RIFLE and AKIN criteria (KDIGO guideline 2012) in trauma patients. We investigated and analyzed the risk factors that may cause acute renal failure using logistic regression analysis.
Results: The penetrating trauma was more frequent than blunt (43.9 % vs. 34.7 %). In 21 cases (21.4 %), road traffic crash was the cause of injury. Multi-organ failure was seen in 2 patients. These patients died on the 7th and 11th days. Hospital mortality was observed in 6 of 98 patients. The mean duration of stay in intensive care unit was 5.1±2.7 days, while total hospital stay was 16.7±3.1 days. Renal dysfunction showing renal destruction findings were seen in 24 patients. Hemodialysis was performed in 12 patients due to renal failure. Age >50, ISS> 20, MESS> 7, blood and blood-product transfusion > 1000cc, volume loading with hydroxyethyl starch, hypotension on admission, hemodynamic shock, and intense soft tissue-muscle trauma significant risk factors for the development of acute renal failure in the logistic regression analysis.
Conclusions: Vascular trauma is one of the medical problems that require emergency surgery. Renal damage is a frequent complication following trauma and is associated with prolonged hospital length of stay and increased mortality. These patients should be closely monitored for renal failure and there should be no delay in hemodialysis when the indication is established.