Using acute kidney injury severity and scoring systems to predict outcome in patients with burn injury

Kuo, George; Yang, Shih-Yi; Chuang, Shiow-Shuh; Fan, Pei‐Chun; Chang, Chih‐Hsiang; Hsiao, Yen-Chang; Chen, Yung‐Chang

doi:10.1016/j.jfma.2016.10.012

Cited by 17 publications

(18 citation statements)

References 33 publications

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“…RRT was reported in 13 studies (4357 patients) with consecutive sampling of patients and used in 12 (8–16) % of all burn patients (Additional file 10). RRT modes were continuous RRT [38, 45, 46, 54, 55], intermittent haemodialysis [47], or unspecified [27, 28, 34, 37, 48, 50, 58].…”

Section: Resultsmentioning

confidence: 99%

Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis

et al. 2020

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BackgroundAcute kidney injury (AKI) is a common complication in burn patients admitted to the intensive care unit (ICU) associated with increased morbidity and mortality. Our primary aim was to review incidence, risk factors, and outcomes of AKI in burn patients admitted to the ICU. Secondary aims were to review the use of renal replacement therapy (RRT) and impact on health care costs.MethodsWe conducted a systematic search in PubMed, UpToDate, and NICE through 3 December 2018. All reviews in Cochrane Database of Systematic Reviews except protocols were added to the PubMed search. We searched for studies on AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE); Acute Kidney Injury Network (AKIN); and/or Kidney Disease: Improving Global Outcomes (KDIGO) criteria in burn patients admitted to the ICU. We collected data on AKI incidence, risk factors, use of RRT, renal recovery, length of stay (LOS), mortality, and health care costs.ResultsWe included 33 observational studies comprising 8200 patients. Overall study quality, scored according to the Newcastle-Ottawa scale, was moderate. Random effect model meta-analysis revealed that the incidence of AKI among burn patients in the ICU was 38 (30–46) %. Patients with AKI were almost evenly distributed in the mild, moderate, and severe AKI subgroups. RRT was used in 12 (8–16) % of all patients. Risk factors for AKI were high age, chronic hypertension, diabetes mellitus, high Total Body Surface Area percent burnt, high Abbreviated Burn Severity Index score, inhalation injury, rhabdomyolysis, surgery, high Acute Physiology and Chronic Health Evaluation II score, high Sequential Organ Failure Assessment score, sepsis, and mechanical ventilation. AKI patients had 8.6 (4.0–13.2) days longer ICU LOS and higher mortality than non-AKI patients, OR 11.3 (7.3–17.4). Few studies reported renal recovery, and no study reported health care costs.ConclusionsAKI occurred in 38% of burn patients admitted to the ICU, and 12% of all patients received RRT. Presence of AKI was associated with increased LOS and mortality.Trial registrationPROSPERO (CRD42017060420)

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Section: Resultsmentioning

confidence: 99%

Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis

et al. 2020

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“…[ 13 ] AKI also predict higher mortality in patients with burns but has not been incorporated into most burn-specific scoring systems. [ 14 – 17 , 34 , 35 ] Yang et al found that early elevation of plasma or urine neutrophil gelatinase–associated lipocalin is associated with early AKI and mortality. [ 36 ]…”

Section: Discussionmentioning

confidence: 99%

“…We also found that higher ABSI score was associated with poorer survival. In addition to the burn-specific scoring system, various scoring systems used in the ICU predict outcome in burn patients [ 4 , 7 , 17 , 40 , 41 ]. Although these scoring systems do not incorporate burn-specific information, they have predictive ability because they are representatives of the overall condition of critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

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Hyperphosphatemia is associated with high mortality in severe burns

et al. 2018

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IntroductionPhosphate level is often deranged during acute illness, regardless of the presence of kidney injury or not. A few studies described that hypophosphatemia may associated with outcome in patients admitted to the burn unit, but the literatures for hyperphosphatemia is limited. Our study aims to evaluate if hyperphosphatemia, one of the sign of severe tissue damage or kidney injury, will associate with mortality of patients with severe burns.Materials and methodsThe study was a post hoc analysis of prospectively collected data from patients admitted to the burn unit between September 2006 and December 2011. Patients were stratified into normophosphatemic or hyperphosphatemic group by baseline plasma phosphate level. The primary endpoint is 90-day mortality.ResultsTotal 301 patients were included (hyperphosphatemia: n = 52; normophosphatemia: n = 249). The hyperphosphatemic group had lower Glasgow Coma Scale, mean arterial blood pressure, hemoglobin level, albumin, and higher TBSA of burns, APACHE II score, ABSI score, Acute kidney injury (AKI), and creatinine. The 90-day mortality was higher in the hyperphosphatemic group than in the normal group (53.8% vs 18.1%, P < .001) and this difference was still significant when adjusting for several confounding factors (hazard ratio, 2.05; 95% CI, 1.17–3.59). Multivariable Cox analysis showed risk factors of mortality included TBSA of burns, hyperphosphatemia, reduced urine output, and APACHE II score.ConclusionsOur study found in addition to TBSA of burns and inhalation injury, baseline hyperphosphatemia in patients with severe burns is also associated with higher mortality.

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“…Acute kidney injury (AKI) is a common, harmful complication with an incidence rate ranging from 28% to 75% in a hospital setting. [ 1 – 4 ] AKI-related adverse effects can potentially be controlled by early intensive intervention. Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome are potentially fatal disorders characterized by high fever, widespread blistering exanthema of macules, and atypical target-like lesions, accompanied by mucosal involvement with a mortality rate of 10% for SJS and more than 30% for TEN.…”

Section: Introductionmentioning

confidence: 99%

The influence of acute kidney injury on the outcome of Stevens–Johnson syndrome and toxic epidermal necrolysis: The prognostic value of KDIGO staging

Lee

et al. 2018

PLoS ONE

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BackgroundStevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome are severe drug-induced cutaneous adverse reactions with high mortality. Acute kidney injury (AKI) was a common complication in an SJS/TEN group and noted as an independent risk factor for mortality in patients with SJS/TEN. To determine whether AKI staging can predict the outcome of patients with SJS/TEN, we compared the discriminative power of an AKI KDIGO staging system with that of SCROTEN, APACHE II, APACHE III, and SOFA.Materials and methodsWe retrospectively analyzed the data of 75 patients who were diagnosed with SJS, TEN, or SJS/TEN overlap syndrome at a tertiary care university hospital between January 1, 2011 and December 31, 2014. The baseline characteristics, biochemical analysis data, medication use, and outcomes of the patients were assessed, and the discriminative ability for predicting mortality was determined for each prognostic model.ResultsOf the 75 patients, 23 (30.7%) had AKI, of whom 13 (56.5%) died during the index admission. Of the prognostic risk models analyzed, the KDIGO staging system showed similar discriminative ability in predicting in-hospital mortality as did the other models. In addition, combining KDIGO with other scoring systems yielded significantly more accurate risk prediction for in-hospital mortality compared with the other individual scores alone, as measured by net reclassification index. The patients with KDIGO stages 2 and 3 exhibited a significantly lower 1-year survival rate than did those with KDIGO stages 0 and 1.ConclusionAKI KDIGO staging has good discriminative ability and is easy to utilize for predicting mortality.

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Using acute kidney injury severity and scoring systems to predict outcome in patients with burn injury

Abstract: Our results revealed that AKI stage has considerable discriminative power for predicting mortality. Compared with other prognostic models, AKI stage is easier to use to assess outcome in patients with severe burn injury.

Cited by 17 publications

References 33 publications

Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis

Acute kidney injury in burn patients admitted to the intensive care unit: a systematic review and meta-analysis

Hyperphosphatemia is associated with high mortality in severe burns

The influence of acute kidney injury on the outcome of Stevens–Johnson syndrome and toxic epidermal necrolysis: The prognostic value of KDIGO staging

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