Association of AKI with Adverse Outcomes in Burned Military Casualties

Stewart, Ian J.; Tilley, Molly A; Cotant, Casey L.; Aden, James K; Gisler, Christopher; Kwan, Hana K.; McCorcle, Jeffery; Renz, Evan M.; Chung, Kevin K.

doi:10.2215/cjn.04420511

Cited by 43 publications

(24 citation statements)

References 28 publications

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“…Previous work demonstrates that AKI is an important risk factor for morbidity and mortality in burn patients, irrespective of dialysis requirement. 11-13,26,27 Reported crude mortality rates in among burn patients with AKI range from 28 to 100%. 1 .…”

Section: Discussionmentioning

confidence: 99%

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et al. 2016

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Objective To determine whether restrictive fluid resuscitation results in increased rates of acute kidney injury (AKI) or infectious complications. Summary Background Data Studies demonstrate that patients often receive volumes in excess of those predicted by the Parkland equation, with potentially detrimental sequelae. However, the consequences of under-resuscitation are not well-studied. Methods Data were collected from a multicenter prospective cohort study. Adults with greater than 20% total burned surface area injury were divided into three groups based on the pattern of resuscitation in the first 24 hours: volumes less than (restrictive), equal to, or greater than (excessive) standard resuscitation (4-6cc/kg/%TBSA). Multivariable regression analysis was employed to determine the effect of fluid group on AKI, burn wound infections (BWI), and pneumonia. Results Among 330 patients, 33% received restrictive volumes, 39% received standard resuscitation volumes, and 28% received excessive volumes. The standard and excessive groups had higher mean baseline APACHE scores (24.2 vs 16, p<0.05 and 22.3 vs 16, p<0.05) than the restrictive group, but were similar in other characteristics. After adjustment for confounders, restrictive resuscitation was associated with greater probability of AKI (OR 3.25, 95% CI 1.18, 8.94). No difference in the probability of BWI or pneumonia among groups was found (BWI: restrictive vs standard OR 0.74, 95%CI 0.39,1.40, excessive vs standard OR 1.40, 95%CI 0.75,2.60, pneumonia: restrictive vs standard, OR 0.52, 95% CI 0.26, 1.05; excessive vs standard, OR 1.12, 95% CI 0.58, 2.14). Conclusions Restrictive resuscitation is associated with increased AKI, without changes in infectious complications.

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Section: Discussionmentioning

confidence: 99%

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et al. 2016

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“…One hundred and ten patients (1.8%) died. The median day of death after injury (interquartile range) was 6 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). These data will be tnerged with data from the sources listed above to complete the full database.…”

Section: Resultsmentioning

confidence: 99%

Derivation of Candidates for the Combat Casualty Critical Care (C4) Database

et al. 2014

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“…Trauma was defined as an externally applied injury, which preceded and precipitated AKI. Those who had burns requiring subspecialty burn unit care were excluded and have been reported separately (6).…”

Section: Methodsmentioning

confidence: 99%

“…PTAKI-associated mortality in casualties requiring RRT has been 63%-75% since the Korean conflict (1,2). Although mortality is unchanged, casualties are increasingly severe, associated with improved resuscitation, surgical, and evacuation capabilities (3)(4)(5)(6)(7)(8)(9). Civilian mortality is similar at 36%-73% (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Bolanos

Yuan

Little

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Mortality and CKD risk have not been described in military casualties with posttraumatic AKI requiring RRT suffered in the Iraq and Afghanistan wars.Design, setting, participants, & measurements This is a retrospective case series of post-traumatic AKI requiring RRT in 51 military health care beneficiaries (October 7, 2001-December 1, 2013, evacuated to the National Capital Region, documenting in-hospital mortality and subsequent CKD. Participants were identified using electronic medical and procedure records.Results Age at injury was 2666 years; of the participants, 50 were men, 16% were black, 67% were white, and 88% of injuries were caused by blast or projectiles. Presumed AKI cause was acute tubular necrosis in 98%, with rhabdomyolysis in 72%. Sixty-day all-cause mortality was 22% (95% confidence interval [95% CI], 12% to 35%), significantly less than the 50% predicted historical mortality (P,0.001). The VA/NIH Acute Renal Failure Trial Network AKI integer score predicted 60-day mortality risk was 33% (range, 6%-96%) (n=49). Of these, nine died (mortality, 18%; 95% CI, 10% to 32%), with predicted risks significantly miscalibrated (P,0.001). The area under the receiver operator characteristic curve for the AKI integer score was 0.72 (95% CI, 0.56 to 0.88), not significantly different than the AKI integer score model cohort (P=0.27). Of the 40 survivors, one had ESRD caused by cortical necrosis. Of the remaining 39, median time to last follow-up serum creatinine was 1158 days (range, 99-3316 days), serum creatinine was 0.8560.24 mg/dl, and eGFR was 118623 ml/min per 1.73 m 2 . No eGFR was ,60 ml/min per 1.73 m 2 , but it may be overestimated because of large/medium amputations in 54%. Twenty-five percent (n=36) had proteinuria; one was diagnosed with CKD stage 2.Conclusions Despite severe injuries, participants had better in-hospital survival than predicted historically and by AKI integer score. No patient who recovered renal function had an eGFR,60 ml/min per 1.73 m 2 at last follow-up, but 23% had proteinuria, suggesting CKD burden.

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Association of AKI with Adverse Outcomes in Burned Military Casualties

Cited by 43 publications

References 28 publications

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Derivation of Candidates for the Combat Casualty Critical Care (C4) Database

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

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