Dysnatremias and survival in adult burn patients: a retrospective analysis.

BACKGROUND/AIMS: Dysnatremias have been evaluated in many populations and have been found to be significantly associated with mortality. However, this relationship has not been well described in the burn population. METHODS: Admissions to the burn center at our institution from January 2003 to December 2008 were examined. Independent variables included gender, age, percentage total body surface area burned (%TBSA), percentage of third-degree burn, inhalation injury, injury severity score (ISS), Acute Kidney Injury Network (AKIN) stage, hypernatremia, and hyponatremia. They were examined via Cox proportional hazard regression models against death. Moderate to severe hypo- and hypernatremia were defined as serum sodium <130 and >150 mmol/l, respectively. RESULTS: In 1,969 subjects with a mean age of 36.3 ± 16.4 years, a median %TBSA of 9 (interquartile range 4-20) and a median ISS of 5 (interquartile range 1-16) hypernatremia occurred in 9.9% (n = 194), while hyponatremia occurred in 6.8% (n = 134) with mortality rates of 33.5 and 13.8%, respectively. Patients without a dysnatremia had a mortality rate of 4.3%. On Cox proportional hazard regression age, %TBSA, ISS, and AKIN stage were found to be significant predictors of mortality. Hypernatremia (HR 2.00, 95% CI 1.212-3.31; p = 0.0066), but not hyponatremia (HR 1.72, 95% CI 0.89-3.34; p = 0.1068) was associated with mortality. CONCLUSIONS: In the burn population, hypernatremia, but not hyponatremia, is an independent predictor of mortality.

Association of rhabdomyolysis with renal outcomes and mortality in burn patients.

The contribution of rhabdomyolysis to acute kidney injury (AKI) in the context of burn injury is poorly studied. We sought to determine the impact of rhabdomyolysis on AKI (defined by the AKI Network classification), renal replacement therapy (RRT), and death. Patients admitted to the burn unit at our institution were examined. Information on sex, age, presence of inhalation injury, electrical burn, percentage TBSA burned, percentage of full-thickness burns, Injury Severity Score, and peak creatine kinase (CK) were recorded. These variables were examined via multivariate logistic regression analysis against AKI Network stage, RRT, and death. Of 1973 consecutive admissions meeting the inclusion criteria, 525 met our eligibility criteria. Log peak CK was found to be correlated with any stage of AKI (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.36-2.16; P < .0001), moderate to severe AKI (OR, 2.09; 95% CI, 1.40-3.11; P = .0003), need for RRT (OR, 1.67; 95% CI, 1.16-2.40; P = .0057), and mortality (OR, 1.49; 95% CI, 1.01-2.20; P = .0441), after adjustment. Each 10-fold increase in peak CK was associated with a 70% increase in the odds of AKI, more than a 100% increase in the odds of moderate to severe AKI, a nearly 70% increase in the odds of RRT, and an almost 50% increase in the odds of mortality in patients with burn injury.