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Acute Kidney Injury in Burn Patients Admitted to the Intensive Care Unit: A Systematic Review and Meta-Analysis

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Acute Kidney Injury in Burn Patients Admitted to the Intensive Care Unit: A Systematic Review and Meta-Analysis

Torgeir Folkestad et al. Crit Care.

Abstract

Background: Acute kidney injury (AKI) is a common complication in burn patients admitted to the intensive care unit (ICU) associated with increased morbidity and mortality. Our primary aim was to review incidence, risk factors, and outcomes of AKI in burn patients admitted to the ICU. Secondary aims were to review the use of renal replacement therapy (RRT) and impact on health care costs.

Methods: We conducted a systematic search in PubMed, UpToDate, and NICE through 3 December 2018. All reviews in Cochrane Database of Systematic Reviews except protocols were added to the PubMed search. We searched for studies on AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE); Acute Kidney Injury Network (AKIN); and/or Kidney Disease: Improving Global Outcomes (KDIGO) criteria in burn patients admitted to the ICU. We collected data on AKI incidence, risk factors, use of RRT, renal recovery, length of stay (LOS), mortality, and health care costs.

Results: We included 33 observational studies comprising 8200 patients. Overall study quality, scored according to the Newcastle-Ottawa scale, was moderate. Random effect model meta-analysis revealed that the incidence of AKI among burn patients in the ICU was 38 (30-46) %. Patients with AKI were almost evenly distributed in the mild, moderate, and severe AKI subgroups. RRT was used in 12 (8-16) % of all patients. Risk factors for AKI were high age, chronic hypertension, diabetes mellitus, high Total Body Surface Area percent burnt, high Abbreviated Burn Severity Index score, inhalation injury, rhabdomyolysis, surgery, high Acute Physiology and Chronic Health Evaluation II score, high Sequential Organ Failure Assessment score, sepsis, and mechanical ventilation. AKI patients had 8.6 (4.0-13.2) days longer ICU LOS and higher mortality than non-AKI patients, OR 11.3 (7.3-17.4). Few studies reported renal recovery, and no study reported health care costs.

Conclusions: AKI occurred in 38% of burn patients admitted to the ICU, and 12% of all patients received RRT. Presence of AKI was associated with increased LOS and mortality.

Trial registration: PROSPERO (CRD42017060420).

Keywords: Acute kidney injury; Burn; Critical illness; Mortality; Outcome; Renal replacement therapy; Risk factor; Systematic review.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of search results according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. ICU, intensive care unit; AKI, acute kidney injury
Fig. 2
Fig. 2
Reported incidence rates of acute kidney injury (AKI) in burn patients admitted to the intensive care unit. N, number of patients in the study; CI, confidence interval; RE, random effect
Fig. 3
Fig. 3
Risk factors for acute kidney injury in burn patients admitted to the intensive care unit. The contribution from the various risk factors were statistically weighted and adjusted to a single scale. Odds ratios (OR) for continuous risk factors were derived from standardised mean differences. CI, confidence interval; ABSI, Abbreviated Burn Severity Index; APACHE, Acute Physiology and Chronic Health Evaluation; SOFA, Sequential Organ Function Assessment; TBSA, Total Body Surface Area; BMI, body mass index; MAP, mean arterial pressure
Fig. 4
Fig. 4
Mortality in burn patients with acute kidney injury (AKI) in the intensive care unit. Odds ratio (OR) for mortality reported at any time point is compared in AKI and non-AKI patients. N AKI, number of AKI patients; CI, confidence interval; RE, random effect

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