Outcome of acute kidney injury in severe burns: a systematic review and meta-analysis

Brusselaers, Nele; Monstrey, Stan; Colpaert, Kirsten; Decruyenaere, Johan; Blot, Stijn; Hoste, Eric

doi:10.1007/s00134-010-1861-1

Cited by 129 publications

(100 citation statements)

References 72 publications

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“…AKI severity, defined by RIFLE, is associated with prognosis in the general population [26] and in some special populations [13,15,27,28] but to our knowledge it has never been tested in critically ill cancer patients, a population with an intrinsically high mortality.…”

Section: Discussionmentioning

confidence: 99%

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Predicting Hospital Mortality in Critically Ill Cancer Patients according to Acute Kidney Injury Severity

et al. 2011

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Background: Acute kidney injury (AKI) is a frequent complication in hospitalized patients, especially in those in intensive care units (ICU). The RIFLE classification might be a valid prognostic factor for critically ill cancer patients. The present study aims to evaluate the discriminatory capacity of RIFLE versus other general prognostic scores in predicting hospital mortality in critically ill cancer patients. Methods: This is a single-center study conducted in a cancer-specialized ICU in Brazil. All of the 288 patients hospitalized from May 2006 to June 2008 were included. RIFLE classification, APACHE II, SOFA, and SAPS II scores were calculated and the area under receiver operating characteristic (AROC) curves and logistic multiple regression were performed using hospital mortality as the outcome. Results: AKI, defined by RIFLE criteria, was observed in 156 (54.2%) patients. The distribution of patients with any degree of AKI was: risk, n = 96 (33.3%); injury, n = 30 (10.4%), and failure, n = 30 (10.4%). Mortality was 13.6% for non-AKI patients, 49% for RIFLE ‘R’ patients, 62.3% for RIFLE ‘I’ patients, and 86.8% for RIFLE ‘F’ patients (p = 0.0006). Logistic regression analysis showed that RIFLE criteria, APACHE II, SOFA, and SAPS II were independent factors for mortality in this population. The discrimination of RIFLE was good (AROC 0.801, 95% CI 0.748–0.854) but inferior compared to those of APACHE II (AROC 0.940, 95% CI 0.915–0.966), SOFA (AROC 0.910, 95% CI 0.876–0.943), and SAPS II (AROC 0.869, 95% CI 0.827–0.912). Conclusion: AKI is a frequent complication in ICU patients with cancer. RIFLE was inferior to commonly used prognostic scores for predicting mortality in this cohort of patients.

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Section: Discussionmentioning

confidence: 99%

“…This classification has already been validated as a prognostic factor for general ICU patients [10,11] and in some specific groups with AKI [12,13,14,15]. Due to the prognostic features imposed by cancer itself on critically ill patients, it is necessary to validate RIFLE criteria in this population.…”

Section: Introductionmentioning

confidence: 99%

Predicting Hospital Mortality in Critically Ill Cancer Patients according to Acute Kidney Injury Severity

et al. 2011

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“…Our method has distinct differences from prior studies. Since regulation of water balance by the kidneys is related to renal function, adjustment for AKI, which is well known to be associated with mortality, particularly in the burn population [18], is imperative. A strength of the present analysis is that we used the AKIN criteria [14] for this purpose.…”

Section: Discussionmentioning

confidence: 99%

Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

Stewart

Morrow²,

Tilley³

et al. 2013

Am J Nephrol

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Background/Aims: Dysnatremias have been evaluated in many populations and have been found to be significantly associated with mortality. However, this relationship has not been well described in the burn population. Methods: Admissions to the burn center at our institution from January 2003 to December 2008 were examined. Independent variables included gender, age, percentage total body surface area burned (%TBSA), percentage of third-degree burn, inhalation injury, injury severity score (ISS), Acute Kidney Injury Network (AKIN) stage, hypernatremia, and hyponatremia. They were examined via Cox proportional hazard regression models against death. Moderate to severe hypo- and hypernatremia were defined as serum sodium <130 and >150 mmol/l, respectively. Results: In 1,969 subjects with a mean age of 36.3 ± 16.4 years, a median %TBSA of 9 (interquartile range 4–20) and a median ISS of 5 (interquartile range 1–16) hypernatremia occurred in 9.9% (n = 194), while hyponatremia occurred in 6.8% (n = 134) with mortality rates of 33.5 and 13.8%, respectively. Patients without a dysnatremia had a mortality rate of 4.3%. On Cox proportional hazard regression age, %TBSA, ISS, and AKIN stage were found to be significant predictors of mortality. Hypernatremia (HR 2.00, 95% CI 1.212–3.31; p = 0.0066), but not hyponatremia (HR 1.72, 95% CI 0.89–3.34; p = 0.1068) was associated with mortality. Conclusions: In the burn population, hypernatremia, but not hyponatremia, is an independent predictor of mortality.

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“…Nevertheless, laboratory markers are probably of a higher use in prediction of sepsis and organ failure, since earlier and more accurate treatment of these complications may result in a better outcome [2,[12][13][14][15]. A high specificity (few false positive) would then be advisable to avoid unnecessary, potentially harmful treatment.…”

Section: Dear Editormentioning

confidence: 99%

Outcome prediction in severe burn injury: clinical versus laboratory markers

Brusselaers

Monstrey

Vogelaers

et al. 2011

Eur J Trauma Emerg Surg

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Outcome of acute kidney injury in severe burns: a systematic review and meta-analysis

Abstract: Despite the wide variation of the analysed burn populations and definitions of AKI, this review clearly showed that AKI remains prevalent and is associated with increased mortality in patients with severe burn injury.

Cited by 129 publications

References 72 publications

Predicting Hospital Mortality in Critically Ill Cancer Patients according to Acute Kidney Injury Severity

Predicting Hospital Mortality in Critically Ill Cancer Patients according to Acute Kidney Injury Severity

Dysnatremias and Survival in Adult Burn Patients: A Retrospective Analysis

Outcome prediction in severe burn injury: clinical versus laboratory markers

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