Predicting Acute Kidney Injury Among Burn Patients in the 21st Century

Abstract

Objective Historically, acute kidney injury (AKI) carried a deadly prognosis in the burn population. Our aim with this study was to provide a modern description of AKI in the burn population and to develop a prediction tool for identifying patients at risk for late AKI. Methods A large multi-institution database, the Glue Grant's trauma related database (TRDB), was used to characterize AKI in a cohort of critically ill burn patients. We defined AKI according to the RIFLE criteria and categorized AKI as early, late or progressive. We then used Classification and Regression Tree (CART) analysis to create a decision tree with data obtained from the first 48 hours of admission to predict which subset of patients would develop late AKI. We tested the accuracy of this decision tree in a separate, single-institution cohort of burn patients who met the same criteria for entry into the Glue Grant study Results Of the 220 total patients analyzed from the Glue Grant cohort, 49 (22.2%) developed early AKI, 39 (17.7%) developed late AKI, and 16 (7.2%) developed progressive AKI. The group with progressive AKI was statistically older, with more comorbidities, and with the worst survival when compared to those with early or late AKI. Using CART analysis, we developed a decision tree with an overall accuracy of 80% for the development of late AKI for the Glue Grant dataset. We then tested this decision tree on a smaller dataset from our own institution to validate this tool, and found it to be 73% accurate. Conclusions AKI is common in severe burns with notable differences between early, late, and progressive AKI. Additionally, CART analysis provided a predictive model for early identification of patients at highest risk for developing late AKI with proven clinical accuracy.

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

“…Most of these are triggered by second-degree burns of the skin 21 , which create more hemodynamic changes from fluid shifts than from third degree wounds, in which all cells are dead. 22,23 In this study, the presence of inhalation injuries, ventilator use, episodes of hypotension in the first 24 hours, and arterial pH were related to AKI, which was also found in the study by Schneider et al 24 The AKI group had a longer average hospital stay and more complications, consistent with other studies. 9,13,14,19,23 Moreover, the mortality in the AKI group in our study was 44.4%, which is in the range of 4%-90% from other studies.…”

Pediatric burn injuries

“…[19] Increased levels of catecholamines and inflammatory mediators result in vasoconstriction of the renal vasculature, which can be further aggravated by myoglobinuria, especially in children with electric burns. A secondary effect of hepatic and renal dysfunction is altered metabolism and elimination of several drugs used routinely in the care of the burn patient.…”

Identifying the Patient at Risk of Acute Kidney Injury: A Predictive Scoring System for the Development of Acute Kidney Injury in Acute Medical Patients

“…An AKI risk index for patients undergoing general surgery has been described where patients developing a rise in serum creatinine >177 μmol/l (>2 mg/dl) or AKI necessitating dialysis were found to have 11 independent preoperative predictors of AKI. In keeping with other work, they also demonstrated an eightfold increase in mortality in patients who developed AKI [14]. However, few attempts have been made to try to identify patients at risk of developing AKI when admitted to hospital as acute medical emergencies outside of critical care.…”