Acute Kidney Injury After Burn: A Cohort Study From the Parkland Burn Intensive Care Unit

Autor: Sarah C. Huen, Herb A. Phelan, Jonathan B. Imran, Orson W. Moe, Rohan Kulangara, Audra T. Clark, Javier A. Neyra, Tarik D. Madni, Beverley Adams-Huet, Brett D. Arnoldo, Steven E. Wolf, Xilong Li
Rok vydání: 2018
Předmět:
Adult
Male
medicine.medical_specialty
medicine.medical_treatment
Population
urologic and male genital diseases
law.invention
030207 dermatology & venereal diseases
03 medical and health sciences
0302 clinical medicine
law
medicine
Humans
Hospital Mortality
Renal replacement therapy
education
Retrospective Studies
Parkland formula
education.field_of_study
business.industry
Rehabilitation
Acute kidney injury
030208 emergency & critical care medicine
Retrospective cohort study
Original Articles
Acute Kidney Injury
Length of Stay
Middle Aged
medicine.disease
Respiration
Artificial

Intensive care unit
female genital diseases and pregnancy complications
Renal Replacement Therapy
Intensive Care Units
Creatinine
Emergency medicine
Emergency Medicine
Female
Surgery
Burns
business
Total body surface area
Cohort study
Zdroj: Journal of Burn Care & Research. 40:72-78
ISSN: 1559-0488
1559-047X
DOI: 10.1093/jbcr/iry046
Popis: Acute kidney injury (AKI) is a common and morbid complication in patients with severe burn. The reported incidence of AKI and mortality in this population varies widely due to inconsistent and changing definitions. They aimed to examine the incidence, severity, and hospital mortality of patients with AKI after burn using consensus criteria. This is a retrospective cohort study of adults with thermal injury admitted to the Parkland burn intensive care unit (ICU) from 2008 to 2015. One thousand forty adult patients with burn were admitted to the burn ICU. AKI was defined by KDIGO serum creatinine criteria. Primary outcome includes hospital death and secondary outcome includes length of mechanical ventilation, ICU, and hospital stay. All available serum creatinine measurements were used to determine the occurrence of AKI during the hospitalization. All relevant clinical data were collected. The median total body surface area (TBSA) of burn was 16% (IQR: 6%–29%). AKI occurred in 601 patients (58%; AKI stage 1, 60%; stage 2, 19.8%; stage 3, 10.5%; and stage 3 requiring renal replacement therapy [3-RRT], 9.7%). Patients with AKI had larger TBSA burn (median 20.5% vs 11.0%; P < .001) and more mechanical ventilation and hospitalization days than patients without AKI. The hospital death rate was higher in those with AKI vs those without AKI (19.7% vs 3.9%; P < .001) and increased by each AKI severity stage (P trend < .001). AKI severity was independently associated with hospital mortality in the small burn group (for TBSA ≤ 10%: stage 1 adjusted OR 9.3; 95% CI, 2.6–33.0; stage 2–3 OR, 35.0; 95% CI, 9.0–136.8; stage 3-RRT OR, 30.7; 95% CI, 4.2–226.4) and medium burn group (TBSA 10%–40%: stage 2–3 OR, 6.5; 95% CI, 1.9–22.1; stage 3-RRT OR, 35.1; 95% CI, 8.2–150.3). AKI was not independently associated with hospital death in the large burn group (TBSA > 40%). Urine output data were unavailable. AKI occurs frequently in patients after burn. Presence of and increasing severity of AKI are associated with increased hospital mortality. AKI appears to be independently and strongly associated with mortality in patients with TBSA ≤ 40%. Further investigation to develop risk-stratification tools tailoring this susceptible population is direly needed.
Databáze: OpenAIRE