Faculty Collaboration Database

Acute Kidney Injury in Burn Patients: Clinically Significant Over the Initial Hospitalization and 1 Year After Injury: An Original Retrospective Cohort Study. Ann Surg 2017 Aug;266(2):376-382

Date

09/10/2016

Pubmed ID

27611620

Pubmed Central ID

PMC5342949

DOI

10.1097/SLA.0000000000001979

Scopus ID

2-s2.0-84986220288 (requires institutional sign-in at Scopus site)   29 Citations

Abstract

OBJECTIVE: To examine the development of acute kidney injury (AKI) after burn injury as an independent risk factor for increased morbidity and mortality over initial hospitalization and 1-year follow-up.

BACKGROUND: Variability in fluid resuscitation and difficulty recognizing early sepsis are major barriers to preventing AKI after burn injury. Expanding our understanding of the burden AKI has on the clinical course of burn patients would highlight the need for standardized protocols.

METHODS: We queried the Healthcare Cost and Utilization Project State Inpatient Databases in the states of Florida and New York during the years 2009 to 2013 for patients over age 18 hospitalized with a primary diagnosis of burn injury using ICD-9 codes. We identified and grouped 18,155 patients, including 1476 with burns >20% total body surface area, by presence of AKI. Outcomes were compared in these cohorts via univariate analysis and multivariate logistic regression models.

RESULTS: During initial hospitalization, AKI was associated with increased pulmonary failure, mechanical ventilation, pneumonia, myocardial infarction, length of stay, cost, and mortality, and also a lower likelihood of being discharged home. One year after injury, AKI was associated with development of chronic kidney disease, conversion to chronic dialysis, hospital readmission, and long-term mortality.

CONCLUSIONS: AKI is associated with a profound and severe increase in morbidity and mortality in burn patients during initial hospitalization and up to 1 year after injury. Consensus protocols for initial burn resuscitation and early sepsis recognition and treatment are crucial to avoid the consequences of AKI after burn injury.

Author List

Thalji SZ, Kothari AN, Kuo PC, Mosier MJ

Author

Anai N. Kothari MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Burns
Early Diagnosis
Female
Hospital Costs
Hospitalization
Humans
Length of Stay
Male
Middle Aged
Patient Readmission
Pneumonia
Renal Dialysis
Renal Insufficiency, Chronic
Respiration, Artificial
Respiratory Insufficiency
Retrospective Studies
Sepsis