516 Higher Risk of Acute Kidney Injury in Burn Patients with Rhabdomyolysis

Abstract

Abstract Introduction Rhabdomyolysis, a rapid breakdown of damaged skeletal muscle, is a serious complication known to occur in approximately 1% of burn patients. Muscle breakdown products can accumulate in the renal tubules leading to acute kidney injury (AKI) and increased deaths. Burn-associated factors such as under-resuscitation, infection, and nephrotoxic drugs likely increase incidence of AKI in those with rhabdomyolysis after burn. Other variables such as age, sex, and pre-existing conditions may also be implicated in this relationship. We investigated whether burn patients with rhabdomyolysis are at greater risk of developing AKI than others with rhabdomyolysis. Methods TriNetX, a global health research network, was accessed in September 2020 to create three patient cohorts with a combination of rhabdomyolysis and burns. Data from years 2000 to 2020 from 38 health care organizations was used. Cohort 1 included burned patients who developed rhabdomyolysis within 14 days after injury. Cohort 2 were those with rhabdomyolysis who did not suffer a burn within 14 days prior to diagnosis. Cohort 3 included burned patients who did not develop rhabdomyolysis within 14 days of the burn. Burn diagnosis was identified by ICD-10 codes T20-25, T26-28, or T30-32; rhabdomyolysis was identified with M62.82. We identified 699 patients in Cohort 1. Propensity score matching was done to Cohorts 2 and 3 to balance similar demographics and pre-existing conditions to Cohort 1. Cohorts were then compared to assess the risk of developing AKI (N17) within 14 days of the initial event. Results Cohort 1 had a mean age at incidence of 48.4±19.8; 552 patients were male and 146 were female. 154 patients with hypertensive diseases, 66 with diabetes mellitus, 41 with chronic kidney disease, and 51 overweight or obese patients were identified. Matched Cohorts 2 and 3 had the same number of patients and similar demographics and pre-existing conditions as Cohort 1. 391 of 699 burn patients with rhabdomyolysis (56%), 293 of 699 non-burn patients with rhabdomyolysis (42%), and 23 of 699 burn patients without rhabdomyolysis (3%) developed AKI within 14 days. The risk ratio difference for developing AKI between burn patients and non-burn patients with rhabdomyolysis was 14.02% with a 95% CI of 8.831–19.209% (< 0.0001 p-value) and between burn patients with and without rhabdomyolysis was 52.647% with a 95% CI of 48.736–56.557% (< 0.0001 p-value). The odds ratios for developing AKI were 1.759 and 37.312, respectively. Conclusions We found the risk of developing AKI in burn patients with rhabdomyolysis to be significantly augmented compared to non-burn patients with rhabdomyolysis or burn patients without rhabdomyolysis.