Abstract:AKI occurs frequently in patients after burn. Presence of and increasing severity of AKI are associated with increased hospital mortality. AKI appears to be independently and strongly associated with mortality in patients with TBSA ≤ 40%. Further investigation to develop risk-stratification tools tailoring this susceptible population is direly needed.
“…We identified 1106 unique studies from the literature search and screened their abstracts. Thirty-three of 286 potentially eligible studies were included in the qualitative and quantitative data synthesis [26–58] (Fig. 1).…”
Section: Resultsmentioning
confidence: 99%
“…1). We requested additional data from the authors of nine publications, whereof four provided data [47, 55, 56, 58], one did not have the data [36], and four did not respond [35, 51, 52, 54]. Fig.…”
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)
“…We identified 1106 unique studies from the literature search and screened their abstracts. Thirty-three of 286 potentially eligible studies were included in the qualitative and quantitative data synthesis [26–58] (Fig. 1).…”
Section: Resultsmentioning
confidence: 99%
“…1). We requested additional data from the authors of nine publications, whereof four provided data [47, 55, 56, 58], one did not have the data [36], and four did not respond [35, 51, 52, 54]. Fig.…”
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)
“…AKI is a well-known risk factor for mortality in children with sepsis, malaria, and critical illness [4-6, 16, 33, 34]. AKI in adult trauma patients is also known to increase the risk of death [35][36][37][38][39], but little is known about AKI in pediatric trauma patients. To our knowledge, this is only the third study to show that AKI in children with trauma significantly increased the risk of death compared to those without AKI (40% vs 6.5%, RR 6.5 with 95% CI 2.2-19.1).…”
Background: Acute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.Methods: Prospective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI. Results: We analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n = 4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2-19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies. Conclusions: AKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.
“…RIFLE (73), AKIN (74) and KDIGO (75) are three commonly used AKI grading standards. The KDIGO diagnostic standard proposed in 2012 had been reported to improve the early diagnosis of kidney injury (59,76) and to reduce the missed diagnosis rate (77), which was conducive to the early diagnosis and treatment of AKI. Our results showed that, compared with RIFLE and AKIN, the prevalence and mortality of RRT in KDIGO were relatively low.…”
Background: To improve the prognosis of burn patients with renal replacement therapy (RRT), we performed this systematic review and meta-analysis.Methods: We searched multiple databases for studies published before February 2020. Studies about adult populations with burn injury, providing epidemiologic data on prevalence or mortality of RRT, were included. Results: A total of selected 58 studies, including 38,787 patients were enrolled in our analysis. The prevalence rates of RRT were 5.14% (95%CI 4.54%-5.74%) in all burn patients and 35.8% (95%CI 29.54%-42.07%) in acute kidney injury (AKI) patients. The prevalence of RRT among burn patients in the intensive care unit (ICU) was 10.92% (95%CI 8.71%-13.14%). The mortality of all burn patients with RRT was 65.52% (95%CI 58.41%-72.64%). The mortality of patients with RRT in ICU was 62.7% (95%CI 53.7%-71.7%). The mortality rate of RRT patients was 30.33% (95%CI 22.06%-38.59%) of the total. There was no significant correlation (r=-0.224, P=0.159) between the year of publication and the mortality of burn patients with RRT. Neither cohort studies nor RCT studies of subgroup analyses show that RRT could reduce the risk of death in burn patients with AKI. Bleeding (10.92%) and secondary infection (9.61%) were the most common RRT-related adverse reactions. Compared with heparin, regional citrate anticoagulation has advantages in superior filter life spans and fewer bleeding episodes. Dialysis-requiring AKI in burn patients could increases the risk of chronic kidney disease progression and end-stage renal disease. About 35% of RRT patients need to maintain hemodialysis temporarily, even if they survive and leave hospital. Conclusions: The prevalence of RRT is not low; approximately, one-third of burn patients with AKI need RRT. The mortality of burn patients with RRT is very high and accounts for 1/3 of the total deaths. There is no evidence that RRT can improve the prognosis of burn patients with AKI. Regional citrate anticoagulation has some advantages in reducing bleeding and extending filter life spans, which may be more suitable for severe burn patients with CRRT.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
