Acute Kidney Injury Prevalent in Military Burn Casualties

After multivariate adjustments, independently associated with increased morbidity, mortality

FRIDAY, Dec. 9 (HealthDay News) -- Acute kidney injury (AKI) is prevalent among military casualties with a burn injury, and is independently associated with increased morbidity and mortality after multivariate adjustments, according to a study published online Dec. 8 in the Clinical Journal of the American Society of Nephrology.

Ian J. Stewart, M.D., from the San Antonio Military Medical Center in Fort Sam Houston, and colleagues evaluated the incidence of AKI, and its effects on morbidity and mortality, in military casualties with burn injuries evacuated from Iraq and Afghanistan. Two schemas were used to classify AKI: the Acute Kidney Injury Network (AKIN) and the Risk-Injury-Failure-Loss-End Stage (RIFLE). Data were recorded for age, gender, percentage of total body surface area burned (TBSA), percentage of full thickness burn, inhalation injury, and injury severity score. The patients with a TBSA of 20 percent or more were analyzed for additional data that could be correlated with poor outcomes. Factors associated with morbidity and mortality were determined through multivariate logistic regression analyses.

The investigators found that the AKI prevalence rates were 23.8 and 29.9 percent according to RIFLE and AKIN criteria, respectively. Logistic regression identified RIFLE categories of risk, injury, and failure and AKIN-2 and AKIN-3 classification of AKI as being significantly associated with death (odds ratios, 15.34, 46.28, 126, 23.70 and 130, respectively). For patients with a TBSA of 20 percent or more, the association with AKIN-3, injury, and failure remained significant. With respect to ventilator and intensive care unit days, there was a strong interaction between TBSA and AKI stage.

"In summary, after adjustment, AKI was associated with increased morbidity and mortality in military burn casualties," the authors write.

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