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LETTER TO THE EDITOR
Year : 2020  |  Volume : 2  |  Issue : 2  |  Page : 46

Severe Burns Complicated by Acute Kidney Injury: Some Nuances Regarding Risk Factors and Mortality Rate


Department of ICU, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium

Date of Submission01-Jul-2020
Date of Acceptance20-Aug-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Patrick M Honore
Department of ICU, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 41020 Brussels
Belgium
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DOI: 10.4103/jtccm.jtccm_9_20

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How to cite this article:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. Severe Burns Complicated by Acute Kidney Injury: Some Nuances Regarding Risk Factors and Mortality Rate. J Transl Crit Care Med 2020;2:46

How to cite this URL:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. Severe Burns Complicated by Acute Kidney Injury: Some Nuances Regarding Risk Factors and Mortality Rate. J Transl Crit Care Med [serial online] 2020 [cited 2021 Dec 2];2:46. Available from: http://www.tccmjournal.com/text.asp?2020/2/2/46/305792



Dear Editor,

We read with great interest the recent article by Folkestad et al. who conclude from their meta-analysis regarding severe burn patients and acute kidney injury (AKI) that AKI occurred in 38% of burn patients admitted to the intensive care unit, and 12% of all patients received renal replacement therapy (RRT).[1] In addition, they found that 43% of burn patients with AKI died, with a mortality rate of 74% in patients undergoing RRT.[1] We would like to make some comments. The authors reported that they were unable to quantify the impact of several relevant risk factors, such as the incidence of intra-abdominal hypertension (IAH), because they were reported in fewer than three studies.[1] This is an unfortunate omission, as in the recent study of Talizin et al., IAH was reported to have occurred in >80% of the cases.[2] In patients with IAH, 76% developed AKI, while in contrast, patients without IAH had an incidence of AKI of 37%.[2] IAH is certainly a major risk factor for AKI in burn patients, and this fact is not put forward in the study of Folkestad et al. The incidence of shock was also unable to be quantified.[1] One of the important risk factors for AKI and death is the need of vasopressors, as shown in the study of Chung et al.[3] Another intriguing number is the mortality of burn patients undergoing RRT, which they reported as 74%.[1] Studies reviewed in this meta-analysis are from a period of 14 years (2004–2018), a span of time in which a number of changes in clinical care have been made. If, for example, we look to a recent study realized by Dado et al. regarding patients receiving continuous RRT (CRRT) while on extracorporeal membrane oxygenation (ECMO), the differences are striking.[4] Indeed, the mortality of patients with veno-venous ECMO (placed for concomitant acute respiratory distress syndrome) plus CRRT was only 39.5%. If that mortality rate, in a cohort of very severe cases such as those, is taken as any indication, it stands to reason that the mortality in burn patients with AKI may too have changed quite significantly. Advances in intensive care medicine, including different approaches to vasopressor use, different targets regarding fluid balance, and the use of ECMO in combination with CRRT, among others, mean that the results of this meta-analysis may not represent the present reality.

Author's contributions

PMH, SR, and DDB designed the article. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

Acknowledgments

We would like to thank Dr. Melissa Jackson for critical review of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Folkestad T, Brurberg KG, Nordhuus KM, Tveiten CK, Guttormsen AB, Os I, et al. Acute kidney injury in burn patients admitted to the intensive care unit: A systematic review and meta-analysis. Crit Care 2020;24:2.  Back to cited text no. 1
    
2.
Talizin TB, Tsuda MS, Tanita MT, Kauss IAM, Festti J, Carrilho CM, et al. Acute kidney injury and intra-abdominal hypertension in burn patients in intensive care. Rev Bras Ter Intensiva 2018;30:15-20.  Back to cited text no. 2
    
3.
Chung KK, Lundy JB, Matson JR, Renz EM, White CE, King BT, et al. Continuous venovenous hemofiltration in severely burned patients with acute kidney injury: A cohort study. Crit Care 2009;13:R62.  Back to cited text no. 3
    
4.
Dado DN, Ainsworth CR, Thomas SB, Huang B, Piper LC, Sams VG, et al. Outcomes among Patients Treated with Renal Replacement Therapy during Extracorporeal Membrane Oxygenation: A Single-Center Retrospective Study. Blood Purif 2020;49:341-7.  Back to cited text no. 4
    




 

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