Early acute kidney injury is associated with in-hospital adverse outcomes in critically ill burn patients: an observational study

  1. Martins, Judith 45
  2. Nin, Nicolás 10
  3. Muriel, Alfonso 89
  4. Peñuelas, Óscar 46
  5. Vasco, Dovami 4
  6. Vaquero, Pablo 45
  7. Schultz, Marcus J 123
  8. Lorente, José A. 4567
  1. 1 Department of Intensive Care, Amsterdam University Medical Centers, location AMC , Amsterdam , The Netherlands
  2. 2 Mahidol Oxford Research Unit, Mahidol University , Bangkok , Thailand
  3. 3 Nuffield Department of Medicine, Oxford University , Oxford , UK
  4. 4 Hospital Universitario de Getafe , Madrid , Spain
  5. 5 Universidad Europea de Madrid , Madrid , Spain
  6. 6 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III , Madrid , Spain
  7. 7 Department of Bioingineering, Universidad Carlos III , Madrid , Spain
  8. 8 Hospital Universitario Ramón y Cajal, IRYCIS , Madrid , Spain
  9. 9 CIBER de Epidemiología y Salud Pública, Instituto de Salud Carlos III , Madrid , Spain
  10. 10 Hospital Español , Montevideo , Uruguay
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Revista:
Nephrology Dialysis Transplantation

ISSN: 0931-0509,  1460-2385

Año de publicación: 2022

Tipo: Artículo

DOI: 10.1093/NDT/GFAC339 GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Nephrology Dialysis Transplantation

Resumen

BackgroundThere are no studies in large series of burn patients on the relationship between acute kidney injury (AKI) and adverse outcomes using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.MethodsWe retrospectively analysed data from a cohort of burn patients admitted to the intensive care unit (ICU) with the diagnosis of burn injury. The diagnosis of AKI over the first 7 days after injury was made according to the KDIGO guidelines. The primary outcome was ICU mortality. We used estimative models using univariable and multivariable logistic regression analyses.ResultsA total of 960 patients were studied and AKI was diagnosed in 50.5%. In multivariable analysis, AKI was associated, as compared with patients without AKI, with ICU mortality {adjusted odds ratio [aOR] 2.135 [95% confidence interval (CI) 1.384–3.293]} and secondary outcomes [kidney replacement therapy, aOR 4.030 (95% CI 1.838–8.835); infection, aOR 1.437 (95% CI 1.107–1.866); hospital mortality, aOR 1.652 (95% CI 1.139–2.697)]. AKI stage 1 was associated with a higher ICU [aOR 1.869 (95% CI 1.183–2.954)] and hospital mortality [aOR 1.552 (95% CI 1.050–2.296)] and infection [aOR 1.383 (95% CI 1.049–1.823)]. AKI meeting the urine output (UO) criterion alone was not associated with increased mortality. Ignoring the UO criterion would have missed 50 (10.3%) cases with AKI.ConclusionThe KDIGO guidelines are useful to diagnose AKI in burn patients. Even the mild form of AKI is independently associated with increased mortality. Considering the UO criterion is important to more accurately assess the incidence of AKI, but AKI meeting the UO criterion alone is not associated with increased mortality.

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