87 The Development of Acute Kidney Injury in Burn Patients Undergoing Computed Tomography with Intravenous Contrast

Abstract

Acute kidney injury (AKI) is a major complication of significant burn injuries and may be a significant cause of patient morbidity and mortality. Contrast-induced nephropathy is one of the common causes of acute renal failure in hospitalized patients. Patients that sustain both burn injuries and blunt traumatic injuries may require computed tomography (CT) imaging as part of their initial management. The purpose of this investigation was to determine if patients with greater than 10% TBSA burns that received CT imaging with IV contrast were more likely to develop AKI during their admission. This is a multicenter retrospective chart review of patients admitted to two level I trauma centers with ≥10% TBSA burns between 2014–2017. Patients were excluded if they were admitted for less than 48 hours or died within 48 hours of admission. The electronic medical record was used to extract patient data such as demographics, TBSA, length of stay, baseline and peak creatinine, if a CT scan with IV contrast was done and amount of fluid given over the initial 24 and 48 hours. A total of 443 patients were included in the study. The average age was 45 years. The average TBSA was 23.1%, ranging from 10%-92%. Sixty-eight of the 443 patients underwent CT scans with IV contrast on admission. The rate of AKI in the total population was 8.8%. The rate of AKI between patients who did or did not receive CT scans was not statistically significant (7.4 vs 9.1%). There was no significant difference in the amount of fluids per TBSA given within the first 24 hours between those who developed an AKI and those who did not (460.9 vs 366.7). Patients who received a CT scan had a higher TBSA (29.3 vs 22.0%, p<.01). Patients who developed an AKI had a significantly higher TBSA than those who did not (44.3 vs 21%, p<.0001). Overall mortality was 11.7%. Patients who developed an AKI had a significantly higher mortality than those patients that did not (70.3% vs 6.2%, p<.0001). There was no significant difference in the development of acute kidney injury in burn patients who received CT scans with IV contrast on admission. Although the patients that received IV contrast had a higher TBSA, there was no difference in the amount of IV fluids given in the first 24 hours. The extent of the burn remains a significant risk factor for the development of AKI. Development of AKI in the burn patient is associated with increased mortality. While there is a risk of contrast induced nephropathy, the risk is not increased in burn patients and this should not prevent a thorough evaluation to rule out additional life threatening injuries in the burn trauma patient. Concern for contrast induced nephropathy should not prevent adequate trauma imaging in the burn patient.