Acute Kidney Injury In Burn Patients Research Articles

Deciphering AKI in Burn Patients: Correlations between Clinical Clusters and Biomarkers.

Acute kidney injury (AKI) is a significant complication in burn patients, impacting outcomes substantially. This study explores the heterogeneity of AKI in burn patients by analyzing creatinine time-series data to identify distinct AKI clusters and evaluating routine biomarkers' predictive values. A retrospective cohort analysis was performed on 2608 adult burn patients admitted to Hangang Sacred Heart Hospital's Burn Intensive Care Unit (BICU) from July 2010 to December 2022. Patients were divided into four clusters based on creatinine trajectories, ranging from high-risk, severe cases to lower-risk, short-term care cases. Cluster A, characterized by high-risk, severe cases, showed the highest mortality and severity, with significant predictors being PT and TB. Cluster B, representing intermediate recovery cases, highlighted PT and albumin as useful predictors. Cluster C, a low-risk, high-resilience group, demonstrated predictive values for cystatin C and eGFR cys. Cluster D, comprising lower-risk, short-term care patients, indicated the importance of PT and lactate. Key biomarkers, including albumin, prothrombin time (PT), cystatin C, eGFR cys, and total bilirubin (TB), were identified as significant predictors of AKI development, varying across clusters. Diagnostic accuracy was assessed using area under the curve (AUC) metrics, reclassification metrics (NRI and IDI), and decision curve analysis. Cystatin C and eGFR cys consistently provided significant predictive value over creatinine, with AUC values significantly higher (p < 0.05) in each cluster. This study highlights the need for a tailored, biomarker-driven approach to AKI management in burn patients, advocating for the integration of diverse biomarkers in clinical practice to facilitate personalized treatment strategies. Future research should validate these biomarkers prospectively to confirm their clinical utility.

Prevalence and outcome of acute kidney injury in burn victims at a tertiary centre in Cape Town, South Africa.

Burn victims commonly experience acute kidney injury (AKI), which can lead to significant morbidity and mortality. To investigate the prevalence of AKI in burn patients, the causes of AKI and the rate of in-hospital mortality. A retrospective cohort study was conducted on patients admitted to the Tygerberg Hospital Burn Unit between 1 April 2018, and 31 March 2019. The study included all burn patients >18 years old, except for those with end-stage kidney disease or cold burn wounds, skin donors or readmissions. AKI was defined using the Kidney Disease Improving Global Outcomes criteria, and multivariable logistic regression was used to identify predictors of AKI and death, along with Kaplan-Meier survival analysis. The prevalence of AKI was 27% (58/215). The most common causes of burns were open fires (37%) and shack fires (17%). Patients with AKI had higher scores on the abbreviated burn severity index (ABSI) (7 v. 5, p<0.01), required more mechanical ventilation (69% v. 33%, p<0.01) and experienced more sepsis (35% v. 12%, p<0.01). Predictors of AKI included ABSI score (adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.21 - 1.80, p<0.01), mechanical ventilation (aOR 7.75, 95% CI 1.23 - 48.65, p=0.03) and high admission lactate (aOR 1.57, 95% CI 1.04 - 2.39, p=0.03). Mortality was higher in patients with AKI (34% v. 6%, p<0.01). ABSI score (aOR 2.16, 95% CI 1.56 - 2.99, p<0.01) and vasopressor use (aOR 7.71, 95% CI 2.15 - 27.60, p<0.01) were identified as predictors of death. The survival analysis revealed that AKI was associated with higher mortality (log rank, p<0.01). The study highlights the high prevalence of AKI among burn victims requiring tertiary care and its association with high mortality rates. Improving living conditions in informal settlements could help prevent burns and their complications.

Early acute kidney injury is associated with in-hospital adverse outcomes in critically ill burn patients: an observational study.

There are no studies in large series of burn patients on the relationship between acute kidney injury (AKI) and adverse outcomes using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. We retrospectively analysed data from a cohort of burn patients admitted to the intensive care unit (ICU) with the diagnosis of burn injury. The diagnosis of AKI over the first 7days after injury was made according to the KDIGO guidelines. The primary outcome was ICU mortality. We used estimative models using univariable and multivariable logistic regression analyses. A total of 960 patients were studied and AKI was diagnosed in 50.5%. In multivariable analysis, AKI was associated, as compared with patients without AKI, with ICU mortality {adjusted odds ratio [aOR] 2.135 [95% confidence interval (CI) 1.384-3.293]} and secondary outcomes [kidney replacement therapy, aOR 4.030 (95% CI 1.838-8.835); infection, aOR 1.437 (95% CI 1.107-1.866); hospital mortality, aOR 1.652 (95% CI 1.139-2.697)]. AKI stage 1 was associated with a higher ICU [aOR 1.869 (95% CI 1.183-2.954)] and hospital mortality [aOR 1.552 (95% CI 1.050-2.296)] and infection [aOR 1.383 (95% CI 1.049-1.823)]. AKI meeting the urine output (UO) criterion alone was not associated with increased mortality. Ignoring the UO criterion would have missed 50 (10.3%) cases with AKI. The KDIGO guidelines are useful to diagnose AKI in burn patients. Even the mild form of AKI is independently associated with increased mortality. Considering the UO criterion is important to more accurately assess the incidence of AKI, but AKI meeting the UO criterion alone is not associated with increased mortality.

Assessment of urinary interleukin-18 in the early post-burn period to predict acute kidney injury of various degrees of burn patients

Background: Early detection of acute kidney injury (AKI) in burn-injured patients can help modify the treatment to prevent progression of acute renal failure and reduce the need for renal replacement therapy. The aim of the study was to evaluate urinary interleukin-18 in the early post-burn period to predict the AKI for the various degrees of burn patients.Methods: This prospective observational study was conducted in the department of nephrology, Dhaka medical college in collaboration with burn and plastic surgery unit of the same medical college hospital, from July 2017 to June 2018 for a period of one year. The 48 burn patients (Age&gt;18 years) who attended in the burn unit of Dhaka medical college, Dhaka of both sexes were enrolled in this study. Data were analyzed by using SPSS 22.0. A value of p&lt;0.05 was considered statistically significant for all tests.Results: In this study, mean age of the burn patients was 32.41±10.59 years. Male female ratio was 3.36:1. Urinary IL-18 in diagnosis of AKI showed accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 93.8%, 91.7%, 94.4%, 84.6% and 97.1% respectively. AUC for urinary IL-18 at admission was 0.968 (CI, 0.921-1.000) and AUC for serum creatinine at admission was 0.937 (CI, 0.871-1.000). Conclusions: According to Kappa value, AUC and sensitivity and specificity urinary IL-18 is a good biomarker in predicting of early AKI in burn patients.

22 Acute Kidney Injury in Burn Patients Following Combination Antibiotic Therapy: A Large Database Analysis

Abstract Introduction Burn patients are prone to infections, which often warrants broad-spectrum antibiotic coverage. Vancomycin is a common antibiotic used at burn centers and is administered alone, or in combination with other agents such as piperacillin-tazobactam (Pip/Tazo). A recent study showed that this combination therapy was associated with increased rates of acute kidney injury (AKI) in adult and pediatric burn patients when compared to vancomycin in combination with other antibiotics. However, other studies failed to demonstrate these findings. The degree of nephrotoxic effect of the combination therapy relative to its drug components has not been demonstrated in burn patients. Using a large national database encompassing 41 health care organizations, we sought to determine whether a combination of vancomycin and Pip/Tazo exacerbates AKI in burn patients. Methods Using the TriNetX Global Health Research Network, we identified the population of burn patients with ICD-10 codes T20-T25 and T30-T32 between 2000–2020. We then grouped this population into 4 cohorts based on the administration of broad-spectrum antibiotics they received after the burn incident: vancomycin, Pip/Tazo alone, combination, and neither vancomycin nor Pip/Tazo. All cohorts were balanced for age, gender, and race. We explored the distribution of these cohorts and conducted comparative outcome analysis to determine the relative risk of developing AKI using the ICD10 code N17. Results Comparative analysis showed burn patients who received vancomycin had a 4.81% increased associated risk with AKI compared to those who did not receive either vancomycin or Pip/Tazo (p&amp;lt; 0.0001, RR =3.35, 95%CI= 2.63–4.26). Patients who received Pip/Tazo monotherapy had a 5.1% increased association with AKI compared to those who did not receive either drug (p&amp;lt; 0.0001, RR =3.57, 95%CI: 2.33–5.45). The combination of vancomycin with Pip/Tazo increased the association with AKI by 9.49% compared to patients who did not receive either drug (p&amp;lt; 0.00001, RR=5.65, 95%CI: 4.40–7.26). Combination therapy also increased the risk of AKI when compared to the vancomycin monotherapy (5.01%, p&amp;lt; 0.00001, RR= 1.69, 95%CI: 1.42–2.00) and Pip/Tazo monotherapy (4.85%, p&amp;lt; 0.00002, RR= 1.62, 95%CI: 4.40–7.26). Conclusions The use of broad-spectrum antibiotics in burn patients is associated with a higher risk of AKI. The combination of these drugs affords an increased relative risk of AKI when compared to monotherapy with the respective component drugs. Whether this is associated with selection bias or drug-effect warrants further investigation.

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

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% (&amp;lt; 0.0001 p-value) and between burn patients with and without rhabdomyolysis was 52.647% with a 95% CI of 48.736–56.557% (&amp;lt; 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.

3 Early Acute Kidney Injury (AKI) Following Major Burns

Abstract Introduction AKI is increasingly recognized as a major complication of burn injury. No studies have specifically examined early AKI in burn patients. The purpose of this study was to examine AKI that develops within the first 7 days of burn injury. Methods Retrospective review of adults with burns &amp;gt; 20% TBSA admitted within 24 hours of injury to an adult regional ABA-verified burn center from 24/11/15 to 1/7/19. We excluded patients that died or who received palliation in the 1st 24 hours following the burn. AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) urine and serum creatinine (s-Cr)-based criteria. The day of burn was defined as day 0. The intake to output ratio in the 1st 24 hours (I:O) was defined as total fluid Intake (mL/kg/%TBSA burn) / urine output (mL/kg). Sepsis was defined using the ABA criteria. Values are presented as median (1st-3rd IQR). Results We included 85 patients with age 46 (31.5–57) yrs., %TBSA burn 30 (23.5–46.9), and 34% with bronchoscopy-confirmed inhalation injury. AKI developed in 53 cases (62.4%) at 0 (0–1) days (range 0–6 days) post burn. Baseline s-Cr was 0.94 mg/dL (0.78–1.24), and peaked at 1.33 mg/dL (1.08–2.24), (P&amp;lt; 0.001). Distribution of AKI severity was 55% Stage I, 19% Stage II, 9% Stage III, and 17% Stage III requiring renal replacement therapy (RRT). No AKI cases had high voltage electrical burns, while 5 (9%) had sepsis and 5 (9%) were receiving vancomycin or an aminoglycoside prior to AKI onset. Comparison of AKI patients to NO AKI patients is shown in the table. High dose vitamin C resuscitation (HDVCR) had been utilized in 78% of the Stage III cases that required RRT. Compared to resuscitation using Ringers Lactate with or without 5% albumin (N= 61), HDVCR was used in 20 (38%) of AKI cases Vs. 4 (13%) of NO AKI cases (p=0.01). The I:O was 0.25 (0.16–0.46) in AKI and 0.19 (0.1–0.33) in NO AKI (p=0.04). Mortality was significantly higher in AKI than NO AKI (38% Vs. 9%, p=0.004) Conclusions Early AKI is highly prevalent following a major burn injury. Patients developing early AKI had significantly greater age, need for mechanical ventilation, and admission SOFA scores. HDVCR may be implicated in the development of early AKI. Applicability of Research to Practice Further study is required on HDVCR’s relationship to AKI.

Does Acute Kidney Injury Condition Affect Revised BAUX Score in Predicting Mortality in Major Burn Patients?

Objective: This study aimed to assess the accuracy of the revised BAUX score for predicting mortality among the major burn patients with acute kidney injury (AKI) compared with non-AKI group. The epidemiologic information and risk factors of AKI in major burn patients were also the point of interest. Methods: This study was a retrospective cohort study. The medical records of 144 major burn patients admitted at the burns unit of Siriraj Hospital from 2010-2016 were reviewed and important data were retrieved. Results: Age, hypertension, diabetes mellitus, severity of the burn injuries, and inhalation injuries were the factors related to AKI in major burn patients. The mortality rate due to AKI in burn patients was high (44.4%). The accuracy of the revised BAUX score in predicting the mortality among the major burn patients from our series was only fair (66.7%). Conclusion: AKI affected on mortality of the major burn patients. Until the better predictor comes up, the revised BAUX score should be considered as a predictor of mortality in these patients.

Risk Factors for Acute Kidney Injury in Patients With Burn Injury: A Meta-Analysis and Systematic Review.

Acute kidney injury (AKI) is a fatal complication of burn injury. Few systematic reviews to date have focused on the risk factors predisposing to AKI in patients with burn injury. The aim of this article is to identify the risk factors for the occurrence of AKI in burn patients, thus providing theoretical evidence for prevention and treatment. We performed a systematic review and meta-analysis of studies determining the prevalence, risk factors, and outcomes of AKI in patients with burn injury. An electronic search (up to April 2016) was performed using Pubmed, Embase, Web of Knowledge, and the Cochrane Library databases. Finally, a total of 18 articles (nine prospective cohort, seven retrospective cohort, two case-control) meeting the eligibility criteria were included. The pooled incidence of AKI was 39.6% (95% confidence interval = 34.7-44.4%). Significant risk factors for the occurrence of AKI included age (odds ratio [OR] = 3.78 [1.28-6.27]), TBSA (OR = 15.66 [11.01-20.31]), full-thickness TBSA (OR = 15.66 [11.01-20.31]), flame burn (OR = 1.56 [1.09-2.25]), inhalation injury (OR = 2.97 [1.80-4.89]), abbreviated burn severity index on admission (OR = 2.42 [1.87-2.98]), sequential organ failure assessment score on admission (OR = 2.69 [1.39-3.98]), baseline blood urea nitrogen (OR = 2.11 [0.72-3.51]), serum creatinine (OR = 2.69 [1.39-3.98]), and sepsis (OR = 4.42 [1.75-11.18]). In addition, burn patients with AKI are more likely to have long stay in intensive care unit and high mortality. AKI is a common complication and occurs at a remarkable rate in burn patients. We identified 10 variables as independent risk factors for the development of AKI in burn patients. Our findings may help clinicians to develop effective preventive and therapeutic strategies and provide appropriate, timely initial treatment.

Plasma Neutrophil Gelatinase–Associated Lipocalin as Early Biomarker for Acute Kidney Injury in Burn Patients

This study evaluated whether measurements of plasma neutrophil gelatinase-associated lipocalin (NGAL) can predict acute kidney injury (AKI) in adult burn patients, and assessed the use of this biomarker in risk stratification. We performed a prospective observational study of consecutive patients with major burns admitted to the burn center within 12 hours of injury. Samples for plasma NGAL assay were obtained three times (at admission, day 3, and day 7). The main outcome measures were occurrence of AKI based on Risk-Injury-Failure classification and mortality. A total 45 patients with burns injury were enrolled. There was a high prevalence (11 of 45, 24.4%) of AKI in burn patients. All patients with AKI developed AKI after hospital day 8. Multivariate logistic regression analysis demonstrated that burn size and abbreviated burn severity index were independent risk factors of AKI. Patients who developed AKI had significantly higher admission plasma NGAL levels, hospital day 3 NGAL levels, and hospital day 7 NGAL levels. Especially, hospital day 7 NGAL levels strongly correlated with AKI. For concentration in plasma NGAL at hospital day 7, the area under the receiver operating characteristic curve was 0.903, sensitivity was 87%, and specificity was 91% for a cutoff value of 125 ng/ml. The mean plasma NGAL at hospital day 7 of patients who died was significantly higher than that of patients who did not (485 ng/ml vs 111 ng/ml, P = .001). Plasma NGAL levels are early predictive biomarkers for AKI and its clinical outcomes after burn injury.