In 2007, the Acute Kidney Injury Network (AKIN) developed a modified standard for diagnosing and classifying acute kidney injury (AKI). This classification system is a modification of the previously described risk, injury, failure, loss, and end-stage (RIFLE) criteria. Among other modifications, the AKIN staging requires an absolute serum creatinine change of 0.3 mg/dl in a 48-hour period to establish the diagnosis of AKI. The purpose of this study was to apply these new criteria in the severely burned population and to compare the prevalence, stage, and mortality impact of these criteria to the RIFLE criteria. The authors performed a retrospective analysis of consecutive patients with burns admitted to their burn center for at least 24 hours from June 2003 through December 2008. Each patient was classified by both the AKIN and RIFLE criteria by three referees. Both univariate and multivariate analyses were performed to determine the impact of the various AKI stages on mortality. A total of 1973 patients met inclusion and exclusion criteria and were included in the analysis. The average age, %TBSA, injury severity score, and percent with smoke inhalation injury were 36 ± 16, 16 ± 18, 10 ± 12, and 13%, respectively. Overall, the prevalence of AKI was 33% using the AKIN criteria and 24% using the RIFLE criteria with an associated mortality of 21 and 25%, respectively. Of those meeting criteria for AKIN stage 1 (N = 434), 41% (N = 180) would have been categorized as not having AKI on the basis of the RIFLE criteria. In this cohort of patients, mortality increased by almost 8-fold when compared with those without AKI (odds ratio 7.8 [95% confidence interval (CI) 3.7-16.2], P < .0001). The area under the receiver operator characteristic curve for in-hospital mortality was significantly higher for the AKIN criteria at 0.877 (95% CI 0.848-0.906) when compared to the RIFLE criteria at 0.838 (95% CI 0.801-0.874; P = .0007). Burn patients identified as having AKI by the AKIN criteria missed by RIFLE appear to be an important cohort. On the basis of our study, AKIN criteria may be more precise and are more predictive of death than the RIFLE criteria in this population. Prospective validation is needed.
[Show abstract][Hide abstract] ABSTRACT: 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.
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.
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.
In the burn population, hypernatremia, but not hyponatremia, is an independent predictor of mortality.
American Journal of Nephrology 01/2013; 37(1):59-64. DOI:10.1159/000346206 · 2.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluated whether measurements of plasma neutrophil gelatinase-associated lipocalin (NGAL) can predict acute kidney injury (AKI) in adult burn patients, and assessed the use of this biomarker in risk stratification. We performed a prospective observational study of consecutive patients with major burns admitted to the burn center within 12 hours of injury. Samples for plasma NGAL assay were obtained three times (at admission, day 3, and day 7). The main outcome measures were occurrence of AKI based on Risk-Injury-Failure classification and mortality. A total 45 patients with burns injury were enrolled. There was a high prevalence (11 of 45, 24.4%) of AKI in burn patients. All patients with AKI developed AKI after hospital day 8. Multivariate logistic regression analysis demonstrated that burn size and abbreviated burn severity index were independent risk factors of AKI. Patients who developed AKI had significantly higher admission plasma NGAL levels, hospital day 3 NGAL levels, and hospital day 7 NGAL levels. Especially, hospital day 7 NGAL levels strongly correlated with AKI. For concentration in plasma NGAL at hospital day 7, the area under the receiver operating characteristic curve was 0.903, sensitivity was 87%, and specificity was 91% for a cutoff value of 125 ng/ml. The mean plasma NGAL at hospital day 7 of patients who died was significantly higher than that of patients who did not (485 ng/ml vs 111 ng/ml, P = .001). Plasma NGAL levels are early predictive biomarkers for AKI and its clinical outcomes after burn injury.
Journal of burn care & research: official publication of the American Burn Association 03/2013; 34(6). DOI:10.1097/BCR.0b013e31827d1f36 · 1.43 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.