AKI after Severe Burn
November 03, 2017 | 10:00 AM - 10:00 AM
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AKI after Severe Burn
- AKI Clinical: Predictors
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Acute Kidney Injury
- 003 AKI: Clinical and Translational
- Clark, Audra T, University of Texas Southwestern, Dallas, Texas, United States
- Kulangara, Rohan, Ut Southwestern medical center, Dallas, Texas, United States
- Li, Xilong, UT Southwestern Medical Center, Dallas, Texas, United States
- Madni, Tarik David, University of Texas Soutwestern, Dallas, Texas, United States
- Imran, Jonathan, University of Texas Southwestern Medical Center, Dallas, Texas, United States
- Wolf, Steven E, University of Texas - Southwestern Medical Center, Dallas, Texas, United States
- Neyra, Javier A., University of Kentucky Medical Center, Lexington, Kentucky, United States
Audra T Clark,
Tarik David Madni,
Steven E Wolf,
Javier A. Neyra,
Acute kidney injury (AKI) is a common and morbid complication in patients with severe burn. We aim to examine the incidence, onset, severity, and mortality of AKI after thermal injury.
A retrospective cohort study of adults with thermal injury admitted to the Burn ICU from 2008-2015 was conducted. Patients with preexisting ESRD, kidney transplant, eGFR<15, or absent serum creatinine (SCr) data were excluded. AKI was defined by SCr-KDIGO criteria. The onset of AKI ≤7 days vs >7 days from ICU admission were used to define early vs late AKI, respectively. Patient- and burn-specific characteristics among those with or without AKI were compared. Multivariable logistic regression with AKI as the independent variable and hospital mortality as the dependent variable was utilized.
1040 patients with thermal injury were included in the study. Mean (SD) age was 48.9 (18.9), 70.5% were men and 16.4% black. The median total body surface area (TBSA) of burn was 16% (IQR: 6-29%). AKI was present in 617 (59%) patients, KDIGO stages: 1, 59.3%, 2, 20.3%, 3, 11.3%, 3D, 9.1%. Early AKI was present in 551/617 (89%) of patients. Patients with AKI had larger TBSA burn (median 20.5% vs 11.0%, p<0.001), received more mechanical ventilation days (median 2.0 vs 0.0, p<0.001), and stayed longer in the hospital (median 21.0 vs 10.0 days, p<0.001). Hospital mortality was higher in those with AKI vs those without AKI: 19.7% vs 4% (p<0.001) and increased by each KDIGO stage (p trend<0.001). AKI was independently associated with hospital mortality (early AKI vs. no AKI adjusted OR 8.69, 95% CI 4.20–18.0; late AKI vs. no AKI adjusted 4.78, 1.61–14.15; early AKI vs. late AKI 1.82, 0.74–4.46). Other independent predictors of hospital mortality were age, TBSA, black race, mechanical ventilation, and inhalational injury.
AKI occurs frequently in patients after thermal injury and portends increased mortality. Further investigation is indicated to develop risk-stratification tools and examine AKI recovery patterns in this susceptible population.