Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults

Michael J. Mosier, Tam N. Pham, Matthew B. Klein, Nicole S. Gibran, Brett D. Arnoldo, Richard L. Gamelli, Ronald G. Tompkins, David Herndon

Research output: Contribution to journalArticle

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Abstract

The incidence and prognosis of acute kidney injury (AKI) developing during acute resuscitation have not been well characterized in burn patients. The recently developed Risk, Injury, Failure, Loss, and End-stage (RIFLE) classification provides a stringent stratification of AKI severity and can allow for the study of AKI after burn injury. We hypothesized that AKI frequently develops early during resuscitation and is associated with poor outcomes in severely burned patients. We conducted a retrospective review of patients enrolled in the prospective observational multicenter study "Inflammation and the Host Response to Injury." A RIFLE score was calculated for all patients at 24 hours and throughout hospitalization. Univariate and multivariate analyses were performed to distinguish the impact of early AKI on progressive renal dysfunction, need for renal replacement therapy, and hospital mortality. A total of 221 adult burn patients were included, with a mean TBSA burn of 42%. Crystalloid resuscitation averaged 5.2 ml/kg/%TBSA, with urine output of 1.0 ± 0.6 ml/kg/hr at 24 hours. Sixty-two patients met criteria for AKI at 24 hours: 23 patients (10%) classified as risk, 32 patients (15%) as injury, and 7 (3%) as failure. After adjusting for age, TBSA, inhalation injury, and nonrenal Acute Physiology and Chronic Health Evaluation II ≥20, early AKI was associated with an adjusted odds ratio 2.9 for death (95% CI 1.1-7.5, P = .03). In this cohort of severely burned patients, 28% of patients developed AKI during acute resuscitation. AKI was not always transient, with 29% developing progressive renal deterioration by RIFLE criteria. Early AKI was associated with early multiple organ dysfunction and higher mortality risk. Better understanding of how early AKI develops and which patients are at risk for progressive renal dysfunction may lead to improved outcomes.

Original languageEnglish (US)
Pages (from-to)83-92
Number of pages10
JournalJournal of Burn Care and Research
Volume31
Issue number1
DOIs
StatePublished - Jan 2010

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Acute Kidney Injury
Kidney
Mortality
Resuscitation
Wounds and Injuries
APACHE
Renal Replacement Therapy
Hospital Mortality
Inhalation
Multicenter Studies
Observational Studies
Hospitalization
Multivariate Analysis
Odds Ratio
Urine
Inflammation
Incidence

ASJC Scopus subject areas

  • Emergency Medicine
  • Rehabilitation
  • Surgery

Cite this

Mosier, M. J., Pham, T. N., Klein, M. B., Gibran, N. S., Arnoldo, B. D., Gamelli, R. L., ... Herndon, D. (2010). Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults. Journal of Burn Care and Research, 31(1), 83-92. https://doi.org/10.1097/BCR.0b013e3181cb8c87

Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults. / Mosier, Michael J.; Pham, Tam N.; Klein, Matthew B.; Gibran, Nicole S.; Arnoldo, Brett D.; Gamelli, Richard L.; Tompkins, Ronald G.; Herndon, David.

In: Journal of Burn Care and Research, Vol. 31, No. 1, 01.2010, p. 83-92.

Research output: Contribution to journalArticle

Mosier, MJ, Pham, TN, Klein, MB, Gibran, NS, Arnoldo, BD, Gamelli, RL, Tompkins, RG & Herndon, D 2010, 'Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults', Journal of Burn Care and Research, vol. 31, no. 1, pp. 83-92. https://doi.org/10.1097/BCR.0b013e3181cb8c87
Mosier, Michael J. ; Pham, Tam N. ; Klein, Matthew B. ; Gibran, Nicole S. ; Arnoldo, Brett D. ; Gamelli, Richard L. ; Tompkins, Ronald G. ; Herndon, David. / Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults. In: Journal of Burn Care and Research. 2010 ; Vol. 31, No. 1. pp. 83-92.
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