Subgroup analysis of continuous renal replacement therapy in severely burned patients.

Jaechul Yoon,Yong-Suk Cho,Youngmin Kim,Dohern Kym,Jun Hur,Haejun Yim,Wook Chun,Emmanuel A Burdmann

doi:10.1371/journal.pone.0189057

Abstract

Continuous renal replacement therapy (CRRT) is administered to critically ill patients with renal injuries as renal replacement or renal support. We aimed to identify predictors of mortality among burn patients receiving CRRT, and to investigate clinical differences according to acute kidney injury (AKI) status. This retrospective observational study evaluated 216 Korean burn patients who received CRRT at a burn intensive care unit. Patients were categorized by AKI status. Data were collected regarding arterial pH, laboratory results, ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF ratio), and urine production. Among surviving patients, CRRT duration and the sequential organ failure assessment score were 6.5 days and 4.7 in the non-AKI group and 23.4 days and 7.4 in the AKI group, respectively (p = 0.003 and p = 0.008). On logistic regression analyses, mortality was significantly associated with a pH of <7.2 (p = 0.004), potassium levels of >5.0 mEg/L (p = 0.045), creatinine levels of >2.0 mg/dL (p = 0.011), lactate levels of >2 mmol/L (p<0.001), a PF ratio of <200 (p = 0.042), and a platelet count of <100,000/μL (p<0.001). In the AKI group, poor outcomes were associated with a pH of <7.2, potassium levels of <5.0 mEg/L, lactate levels of >2 mmol/L, and a platelet count of <100,000/μL, while good outcomes were associated with creatinine levels of >2 mg/dL. In the non-AKI group, poor outcomes were associated with lactate levels of >1.5 mmol/L, a PF ratio of <200, and a platelet count of <100,000/μL, while good outcomes were associated with creatinine levels of >1.2 mg/dL. Duration of the CRRT application and the requirement for either renal replacement or renal support at the initiation of CRRT application are important considerations depending on its application.

Highlights

Burn injuries have devastating physical, physiological, and psychological effects, and are associated with high rates of morbidity and mortality
Thrombocytopenia is associated with higher risks of mortality in sepsis cases[20] and acute respiratory distress syndrome (ARDS) cases[21], and thrombocytopenia may reflect the severity of the disease if Continuous renal replacement therapy (CRRT) is performed regardless of acute kidney injury (AKI); this could explain the importance of thrombocytopenia as a risk factor
CRRT is an important treatment for critically ill patients and burn cases, which have a high risk of mortality

Summary

Introduction

Burn injuries have devastating physical, physiological, and psychological effects, and are associated with high rates of morbidity and mortality. Acute kidney injury (AKI) is a common complication in burn patients with an incidence of 1–40% and the associated mortality rate is 50– 100% [4]. Critical care improvements during the last decade have helped decrease the mortality rate among burn cases, burns remain an important global cause of disability and death [5]. Continuous renal replacement therapy (CRRT) is an important critical care treatment that is generally provided to critically ill patients for renal replacement (in cases of AKI) or for renal support (in cases without AKI) [6]. The present study aimed to retrospectively identify factors that predicted mortality among burn cases treated using CRRT, and to investigate any clinical differences according to whether the patients had AKI (i.e., renal replacement vs renal support)

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