Organ failure after major trauma is relatively common. Acute renal failure can occur for a variety of reasons, and tends to occur early. This abstract from Denver Health looked at acute kidney injury as a predictor for the development of multiple organ failure.

The authors retrospectively reviewed 12 years of their registry data for patients at high risk for developing organ failure. They found that multiple organ failure (MOF) developed in 21% and that 8% died. They also noted that if acute kidney injury (AKI, serum creatinine > 1.8mg/dL) occurred by day 2, it predicted the failure of additional organs. Specifically, 80% of these patients developed MOF, with a 34% mortality. Renal failure was a better predictor of multiple organ failure than heart, liver or pulmonary failure seen on day 2.

Bottom line: Early kidney failure, as shown by creatinine elevation, is a reliable predictor of multiple organ failure in severely injured patients. Prevention of acute kidney injury makes sense and may help, but further investigation is needed to demonstrate the mechanism.

Reference: Acute kidney injury and post-trauma multiple organ failure: the canary in the coal mine. AAST 2011 Annual Meeting, Paper 20.