Acute renal dysfunction in severely burned adults

Background: Factors contributing to mortality in burned children with acute renal failure have been identified; however, they have not been identified in thermally injured adults. Methods: The records of 1,404 acutely burned adults admitted to the Blocker Burn Unit were reviewed. Seventy-six patients with acute renal dysfunction and burns covering more than 30% of their total body surface area with a full-thickness component greater than 10% total body surface area were identified. These patients were divided into those admitted from 1981 through 1989 (n = 35) and those admitted from 1990 to 1998 (n = 41). Results: No significant differences could be shown in the incidence of acute renal dysfunction (5.4 vs. 5.1%) or mortality (88 vs. 87%) for the two time periods, respectively. Sixty-seven percent of the survivors were younger than 40 years of age, compared with only 25% of nonsurvivors (p < 0.02); sepsis was identified in 44 and 96% of survivors and nonsurvivors, respectively (p < 0.001). Fluid resuscitation was delayed in survivors by 1.7 ± 1.0 hours compared with 4.4 ± 2.1 hours in nonsurvivors (p < 0.001). Conclusion: Early fluid resuscitation and the prevention of sepsis may reduce the incidence of acute renal dysfunction and mortality in burned adults.