Fluid resuscitation mediates the association between inhalational burn injury and acute kidney injury in the major burn population
| Autor: | Jonathan P. Wanderer, Avinash B. Kumar, Blair Summitt, Matthew S. Shotwell, Yaping Shi, Scott Dennis, William Andrews |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Burn injury Critical Care Population Poison control Lung injury Kidney Function Tests Critical Care and Intensive Care Medicine Cohort Studies 03 medical and health sciences Injury Severity Score 0302 clinical medicine Risk Factors Odds Ratio medicine Humans 030212 general & internal medicine education Aged Retrospective Studies education.field_of_study Thermal injury business.industry Incidence Acute kidney injury 030208 emergency & critical care medicine Retrospective cohort study Odds ratio Acute Kidney Injury Middle Aged medicine.disease Tennessee Intensive Care Units Logistic Models Creatinine Anesthesia Multivariate Analysis Fluid Therapy Female business Burns Inhalation |
| Zdroj: | Journal of Critical Care. 38:62-67 |
| ISSN: | 0883-9441 |
| DOI: | 10.1016/j.jcrc.2016.10.008 |
| Popis: | Background It is known that acute respiratory distress syndrome and acute lung injury are independent risk factors for developing acute kidney injury (AKI) through complex pathophysiologic mechanisms. Our specific aim is to evaluate the risk factors for AKI postburn injury and whether inhalation thermal injury is an independent risk factor for developing AKI in the major burn population. Methods This is an institutional review board–approved, retrospective cohort study of patients admitted to a tertiary burn intensive care unit between 2011 and 2013. We included adults (age 18 years or older) with major burn injury greater than or equal to 20% total burn surface area (TBSA) and patients with confirmed inhalation injury (±major burn). Acute kidney injury was defined using the acute kidney injury network serum creatinine criteria up to 5 days after admission. Patient demographics and clinical data were compared across cohorts using the Wilcoxon rank sum test or Pearson χ 2 test, as appropriate. Multiple logistic regression was used to assess the effect of inhalation injury and major burn on the incidence of AKI, adjusting for clinical and demographic confounders. Results Two hundred fifty-four patient records (90 with inhalation injury and 164 with major burn only) were evaluated. The mean age on admission was 47 ± 19 years and 72% of the cohort were men. There were more men in the major burn group (78% vs 62%; P = .007). No other significant differences were observed in the baseline demographics. The overall incidence of AKI was 28% (95% confidence interval, 22, 33). The unadjusted odds of AKI were nearly double (odds ratio, 1.99; 95% confidence interval, 1.13, 3.49) among those with inhalation injury relative to those with major burn only. However, there was no evidence of an independent inhalational injury effect after adjusting for potential confounders. In particular, TBSA ( P = .051), daily 24-hour fluid balance ( P P = .002) were all significantly associated with AKI in the adjusted analysis. Age and packed red blood cell transfusion status were not significant. Conclusion Inhalation thermal injury is not an independent risk factor for AKI after adjusting for TBSA and surrogates for fluid resuscitation. In patients with major burns, intensity of fluid resuscitation may mediate the development of AKI. |
| Databáze: | OpenAIRE |
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