Increased creatinine clearance in polytrauma patients with normal serum creatinine: a retrospective observational study

INTRODUCTION: The aim of this study, performed in an intensive care unit (ICU) population with a normal serum creatinine, was to estimate urinary creatinine clearance (CL(CR)) in a population of polytrauma patients (PT) through a comparison with a population of non trauma patients (NPT). METHODS: This was a retrospective, observational study in a medical and surgical ICU in a university hospital. A total of 284 patients were consecutively included. Two different groups were studied: PT (n = 144) and NPT (n = 140). Within the second week after admission to the ICU, renal function was assessed using serum creatinine, 24 h urinary CL(CR ). RESULTS: Among the 106 patients with a CL(CR )above 120 mL minute(-1 )1.73 m(-2), 79 were PT and 27 NPT (P < 0.0001). Only 63 patients had a CL(CR )below 60 mL minute(-1 )1.73 m(-2 )with 15 PT and 48 NPT (P < 0.0001). Patients with CL(CR )greater than 120 mL minute(-1). 1.73 m (-2 )were younger, had a lower SAPS II score and a higher male ratio as compared to those having CL(CR )lower than 120 mL minute(-1). 1.73 m (-2). Through a logistic regression analysis, age and trauma were the only factors independently correlated to CL(CR). CONCLUSIONS: In ICU patients with normal serum creatinine, CL(CR), is higher in PT than in NPT. The measure of CL(CR )should be proposed as routine for PT patients in order to adjust dose regimen, especially for drugs with renal elimination.