Haptoglobin use and acute kidney injury requiring renal replacement therapy among patients with severe burn injury: a nationwide database study

Abstract

a BStra ct BackgrOundPrevious studies have suggested that haptoglobin may be beneficial for preventing acute kidney injury (AKI) after severe burns. Although haptoglobin has been approved for the treatment of haemoglobinuria and subsequent AKI in Japan, robust evidence for this is lacking. We examined whether haptoglobin may be effective in preventing AKI requiring renal replacement therapy among patients with severe burns. MethOdSWe performed propensity score-matched analyses of the Japanese nationwide Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) whose data were recorded from 1 July 2010 to 31 March 2013. We compared patients who were administered haptoglobin within 2 days of admission (haptoglobin group) and those who were not administered haptoglobin (control group). The main outcomes were: requirement for renal replacement therapy during admission, 28-day inhospital mortality, length of hospital stay and ventilator-free days. reSultS Eligible patients (n = 3223) from 618 hospitals were categorized into either the haptoglobin group (n = 263) or the control group (n = 2960). Propensity score matching created a matched cohort of 185 pairs with and without haptoglobin. There were no significant differences between the propensity score-matched groups in terms of the proportion of patients requiring renal replacement therapy (control vs haptoglobin, 25.9% vs 31.9%; p = 0.25), ventilator-free days (13 vs 6 days, p = 0.95), length of hospital stay (38 vs. 27, p = 0.45) and 28-day mortality (42.7% vs 46.5%, p = 0.53). cOncluSiOnS Our results suggest that haptoglobin use is not associated with reduced requirement for renal replacement therapy, increased ventilator-free days, length of hospital stay, or reduced 28-day mortality in patients with severe burns.

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“…Several DPC data on different medical fields and diseases, including cancer [ 21 ], cardiovascular [ 22 ], trauma [ 23 ], burns [ 24 ], hematologic [ 15 ], respiratory [ 25 ], gastrointestinal [ 17 ], and cerebrovascular [ 24 ] diseases have been published. However, some limitations have been pointed out in these studies [ 11 , 19 , 21 – 25 ]. For example, the DPC data do not include vital signs, laboratory data, systemic and respiratory variables that represent the pathophysiology of severe pneumonia and are related to the prognosis (i.e., sequential organ failure assessment score, PaO2/FiO2, ventilator settings, and positive end-expiratory pressure level) or cause of death.…”

“…The names of the main disease, disease that led to hospitalization, disease that required the most and second most medical resources, and comorbidity at the time of hospitalization were all coded by the International Classification of Diseases, 10th Revision. In addition to the name of the surgery, current pregnancy, height, weight, smoking index, and Japan Coma Scale scores on admission; all medical and surgical procedures; and records of all prescribed drugs and devices were included in the DPC data [11][12][13]. To guarantee the validity of the coding, the physicians in charge were tasked to record the diagnoses regarding the medical charts.…”