Contribution of Acute Kidney Injury Toward Morbidity and Mortality in Burns: A Contemporary Analysis

Coca, Steven G.; Bauling, Paul; Schifftner, Tracy L.; Howard, Clancy S.; Teitelbaum, Isaac; Parikh, Chirag R.

doi:10.1053/j.ajkd.2006.12.018

Cited by 131 publications

(113 citation statements)

References 26 publications

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“…Similar results have been observed in the hospitalized population as a whole (7), patients undergoing cardiac surgery (8), and burn patients (9)(10)(11).…”

Section: Introductionsupporting

confidence: 82%

Association of AKI with Adverse Outcomes in Burned Military Casualties

Stewart

Tilley

Cotant

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Although associated with increased morbidity and mortality, AKI has not been systematically examined in military personnel injured from combat operations in Iraq and Afghanistan.Design, settings, participants, & measurements Patients evacuated from Iraq and Afghanistan to a burn unit were examined. AKI was classified by the Acute Kidney Injury Network (AKIN) and Risk-Injury-Failure-Loss-End Stage (RIFLE) schemas. Age, sex, percentage of total body surface area burned (TBSA), percentage of fullthickness burn, inhalation injury, and injury severity score were recorded. Additional data that could be associated with poor outcomes were recorded for patients with TBSA $20%. Multivariate logistic regression analyses were performed to determine factors associated with morbidity and mortality.Results AKI prevalence rates by the RIFLE and AKIN criteria were 23.8% and 29.9%, respectively. After logistic regression, RIFLE categories of risk (odds ratio [OR], 15.34; 95% confidence interval [CI], 1.75-134; P=0.01), injury (OR, 46.28; 95% CI, 5.02-427; P,0.001), and failure (OR, 126; 95% CI, 13.39-.999; P,0.001); AKIN-2 (OR, 23.70; 95% CI, 2.32-242; P=0.008); and AKIN-3 (OR, 130; 95% CI, 13.38-.999; P,0.001) were significantly associated with death. AKIN-3, injury, and failure remained significant in the subset of patients with $20% TBSA. There was also a strong interaction between TBSA and the stage of AKI with respect to ventilator and intensive care unit days.Conclusions AKI is prevalent in military casualties with burn injury and is independently associated with morbidity and mortality after adjustment for factors associated with injury severity.

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“…Similar results have been observed in the hospitalized population as a whole (7), patients undergoing cardiac surgery (8), and burn patients (9)(10)(11).…”

Section: Introductionsupporting

confidence: 82%

Association of AKI with Adverse Outcomes in Burned Military Casualties

Stewart

Tilley

Cotant

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Recently, the RIFLE criteria were applied in a single-center study of 304 critically ill burn patients (>10% total-body surface area). [22] In this study, AKI occurred in 26.6% and was associated with longer duration of mechanical ventilation, longer stay in hospital, and higher mortality. [25] Our findings suggest that the burden of early AKI in trauma may be greater than previously appreciated, and that this may have important health resource implications.…”

Section: Discussionmentioning

confidence: 56%

“…[6] To date, only a few studies have described the epidemiology of AKI attributable to trauma. [21][22][23][24][25][26][27] Morris et al performed a retrospective study of 72,757 admissions to nine regional trauma centers over a five-year period and found only 78 patients (0.1%) developed AKI requiring renal replacement therapy (RRT). [25] While these data might suggest AKI in trauma is rare, it did not focus on trauma requiring ICU admission.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, this study found that AKI in trauma was associated with a longer duration of mechanical ventilation and stay in ICU. [21] Emerging data suggest that the burden of AKI in trauma may be increasing; however, most studies to date are limited by small sample size, [23,24,26] single-center design, [21,26,28] focus on selected trauma populations, [22] or use of variable definitions for AKI, [21,25,27] or are potentially confounded by including late or delayed-onset of AKI that may not be attributable to trauma. [21,25,27] An evaluation of the epidemiology of AKI in trauma is important for health resource allocation, identification of high risk populations, development of preventative strategies, and for surveillance of long-term clinical consequences.…”

Section: Introductionmentioning

confidence: 99%

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A Multi-Center Evaluation of Early Acute Kidney Injury in Critically Ill Trauma Patients

et al. 2008

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“…The incidence of AKI is increasing, and the mortality of AKI remains unacceptably high (3,4). AKI is linked with an independent risk of death in multiple cohort studies (5,6). Although the early hazard of AKI has been demonstrated, the long-term consequences of AKI in survivors are not as well appreciated.…”

Section: Introductionmentioning

confidence: 99%

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Chawla

Amdur

Shaw

et al. 2014

Clinical Journal of the American Society of Nephrology

268

228

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Background and objectives AKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.Design, setting, participants, & measurements Patients in the Veterans Affairs (VA) database who had a discharge diagnosis with International Classification of Diseases, Ninth Revision, code of 584.xx (AKI) or 410.xx (MI) and were admitted to a VA facility from October 1999 through December 2005 were selected for analysis. Three groups of patients were created on the basis of the index admission diagnosis and serum creatinine values: AKI, MI, or MI with AKI. Patients with mean baseline estimated GFR,45 ml/min per 1.73 m 2 were excluded. The primary outcomes assessed were mortality, MAKE, and MACE during the study period (maximum of 6 years). The combination of MAKE and MACE-major adverse renocardiovascular events (MARCE)-was also assessed.Results A total of 36,980 patients were available for analysis. Mean age6SD was 66.8611.4 years. The most deaths occurred in the MI+AKI group (57.5%), and the fewest (32.3%) occurred in patients with an uncomplicated MI admission. In both the unadjusted and adjusted time-to-event analyses, patients with AKI and AKI+MI had worse MARCE outcomes than those who had MI alone (adjusted hazard ratios, 1.37 [95% confidence interval, 1.32 to 1.42] and 1.92 [1.86 to 1.99], respectively).Conclusions Veterans who develop AKI in the setting of MI have worse long-term outcomes than those with AKI or MI alone. Veterans with AKI alone have worse outcomes than those diagnosed with an MI in the absence of AKI.

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Contribution of Acute Kidney Injury Toward Morbidity and Mortality in Burns: A Contemporary Analysis

Cited by 131 publications

References 26 publications

Association of AKI with Adverse Outcomes in Burned Military Casualties

Association of AKI with Adverse Outcomes in Burned Military Casualties

A Multi-Center Evaluation of Early Acute Kidney Injury in Critically Ill Trauma Patients

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

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