Abstract
IntroductionProteinuria in burn patients is common, and may be associated with acute kidney injury (AKI) and adverse outcomes. We evaluated the incidences, outcomes, characteristics and determinants of proteinuria and its influence on AKI and outcomes in burn patients.MethodsThis retrospective study was carried out in a hospital's burn department. The study population consisted of patients with burn injuries admitted during a five-year period. Positive urine dipstick readings were defined as mild (± or 1+) or heavy (≥ 2+) proteinuria, and AKI was diagnosed and staged according to the Risk, Injury, Failure, Loss, End Stage (RIFLE) classification system. Patient characteristics, management and outcomes were evaluated for associations with proteinuria using nonparametric tests, chi-square (χ2) tests and binary logistic regression.ResultsOf the patients admitted to the burn unit during the study period (n = 2,497), 865 (34.64%) were classified as having proteinuria. In the patients whose total burn surface areas (TBSA) were > 30% (n = 396), 271 patients (68.43%) had proteinuria and 152 of these patients (56.09%) met AKI criteria. No patients without proteinuria developed AKI. Intensive care unit (ICU) mortality rates were 0.8%, 16.67% and 30.77% (P < 0.001) in the groups with no, mild and heavy proteinuria, respectively. Logistic regression analysis identified proteinuria (OR 4.48; 95% CI, 2.824 to 7.108; P < 0.001) and sequential organ failure assessment (OR 1.383; 95% CI, 1.267 to 1.509; P < 0.001) as risk factors for AKI.ConclusionsWe observed a high prevalence of proteinuria in patients with severe burns (> 30% TBSA). Severely burned patients with proteinuria had a high risk of developing AKI and a poor prognosis for survival. This suggests that proteinuria should be used for identifying burn patients at risk of developing AKI.
Highlights
Proteinuria in burn patients is common, and may be associated with acute kidney injury (AKI) and adverse outcomes
In conclusion, proteinuria was common (68.26%) in severe burn patients (> 30% total burn surface areas (TBSA)), and proteinuria was clearly associated with increased risk for developing AKI, long-term intensive care unit (ICU) stays and mortality
TBSA and sepsis were considered as independent risk factors for proteinuria in the post-burn period, and maximum Sequential Organ Failure Assessment (SOFA) and proteinuria as risk factors for AKI
Summary
Proteinuria in burn patients is common, and may be associated with acute kidney injury (AKI) and adverse outcomes. Acute kidney injury (AKI) is increasingly common and is associated with adverse short- and long-term outcomes in various clinical settings [1], including patients with severe burns [2]. As defined by the RIFLE (Risk, Injury, Failure, Loss, End Stage) classification system, the diagnosis of AKI is currently based on changes in the serum creatinine (sCr) or urine output [12,13]. These parameters often lag behind acute changes in renal function and, underestimate the degree of renal dysfunction in acute care settings [14]. We hypothesized that burn patients with proteinuria would be at higher risk of AKI and adverse outcomes than patients without proteinuria
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