Prediction of major adverse kidney events in critically ill burn patients

Burns. 2018 Dec;44(8):1887-1894. doi: 10.1016/j.burns.2018.08.007. Epub 2018 Oct 12.

Abstract

Objective: We aimed at assessing the predictive value of plasmatic Neutrophil Gelatinase Associated Lipocalin (pNGAL) at admission and severity scores to predict major adverse kidney events (MAKE, defined as death and/or need for renal replacement therapy (RRT) and/or non-renal recovery at day 90) in critically ill burn patients.

Material and methods: Single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients (total burned body surface >20%) from January 2012 until January 2015 with a pNGAL dosage at admission. Reclassification of patients was assessed by Integrated Discrimination Improvement (IDI).

Measurements and results: 87 patients were included. Mean age was 47.7 (IQ 25-75: 33.4-65.2) years; total burn body surface area was 40 (IQ 25-75: 30-55) % and ICU mortality 36%. 39 (44.8%) patients presented a MAKE, 32 (88.9%) patients died at day 90. pNGAL was higher in the MAKE group (423 [IQ 25-75: 327-518]pg/mL vs 184 [IQ 25-75: 147-220]pg/mL, p<0.001). In multivariate analysis, pNGAL and abbreviated burn severity index (ABSI) remained associated with MAKE (OR 1.005 [CI 95% 1.0005-1.009], p=0.03 and OR 1.682 [CI95%1.038-2.726], p=0.035 respectively). Adding pNGAL to abbreviated burn severity index, simplified organ failure assessment and the simplified acute physiology score 2 did outperform clinical scores for the prediction of MAKE and AKI and for most severe forms of AKI and allowed a statistically significant reclassification of patients compared to ABSI for MAKE, RRT, AKI at Day 7 and AKI during hospitalization with a number of patients needed to screen to detect one extra episode of MAKE was 44, 13 for severe AKI and 15 for AKI.

Conclusions: pNGAL at admission is associated with the risk of MAKE in this population, and outperform severity scores when associated. Interventional studies are now needed to assess if impact of biomarkers-guided strategies would improve outcome.

Keywords: Acute kidney injury; Burn patients; Major adverse kidney event; Plasmatic Neutrophil Gelatinase-Associated Lipocain.

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / epidemiology
  • Acute Kidney Injury / metabolism
  • Adult
  • Aged
  • Burns / blood*
  • Burns / metabolism
  • Burns / mortality
  • Cohort Studies
  • Creatinine / metabolism
  • Critical Illness*
  • Female
  • Humans
  • Intensive Care Units
  • Lipocalin-2 / blood*
  • Male
  • Middle Aged
  • Mortality*
  • Prognosis
  • Prospective Studies
  • Recovery of Function*
  • Renal Replacement Therapy / statistics & numerical data*
  • Risk Assessment

Substances

  • LCN2 protein, human
  • Lipocalin-2
  • Creatinine