Mosier et al evaluated the impact of early acute kidney injury (AKI) on an adult with severe burn injury. Certain findings can help to identify a patient at increased risk for mortality. The authors are from the University of Washington Seattle, UT Southwestern Parklands Memorial Hospital, Loyola University, Massachusetts General Hospital and UT Medical Branch Galveston.
Patient selection: adult with severe burn injury and early acute kidney injury (occurring in the first 24 hours after burn injury)
Exclusion: pre-injury chronic renal insufficiency
Risk factors for increased mortality:
(1) persistence and progression of renal dysfunction (not transient)
(2) development of multiple organ failures (MOF, involving >= 2 of cardiac, pulmonary or hepatic systems)
Risk factors for development of early AKI from multivariate analysis:
(1) older age (mean 50.8; use > 50 years in implementation)
(2) lower preadmission fluid administration ratio (for observed to expected)
Additional factors:
(1) any comorbidities present
(2) lower urine output (around lower end of recommended 0.5 to 1.0 mL per kg per hour)
(3) worst base deficit (indicative of metabolic acidosis) in the initial 24 hours
