Early acute kidney injury is associated with in-hospital adverse outcomes in critically ill burn patients: an observational study.

BACKGROUND: There are no studies in large series of burn patients on the relationship between acute kidney injury (AKI) and adverse outcomes using the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. METHODS: We retrospectively analysed data from a cohort of burn patients admitted to the intensive care unit (ICU) with the diagnosis of burn injury. The diagnosis of AKI over the first 7 days after injury was made according to the KDIGO guidelines. The primary outcome was ICU mortality. We used estimative models using univariable and multivariable logistic regression analyses. RESULTS: A total of 960 patients were studied and AKI was diagnosed in 50.5%. In multivariable analysis, AKI was associated, as compared with patients without AKI, with ICU mortality {adjusted odds ratio [aOR] 2.135 [95% confidence interval (CI) 1.384-3.293]} and secondary outcomes [kidney replacement therapy, aOR 4.030 (95% CI 1.838-8.835); infection, aOR 1.437 (95% CI 1.107-1.866); hospital mortality, aOR 1.652 (95% CI 1.139-2.697)]. AKI stage 1 was associated with a higher ICU [aOR 1.869 (95% CI 1.183-2.954)] and hospital mortality [aOR 1.552 (95% CI 1.050-2.296)] and infection [aOR 1.383 (95% CI 1.049-1.823)]. AKI meeting the urine output (UO) criterion alone was not associated with increased mortality. Ignoring the UO criterion would have missed 50 (10.3%) cases with AKI. CONCLUSION: The KDIGO guidelines are useful to diagnose AKI in burn patients. Even the mild form of AKI is independently associated with increased mortality. Considering the UO criterion is important to more accurately assess the incidence of AKI, but AKI meeting the UO criterion alone is not associated with increased mortality.

Physiological parameter values in greyhounds before and after high-intensity exercise.

Dog sports competitions have greatly expanded. The availability of reference values for each type of activity could help assess fitness accurately. Heart rate (HR), blood lactate (BL) and rectal temperature (RT) are relevant physiological parameters to determine the dogs response to effort. Previous studies in greyhounds have reported the effect of high-intensity exercise on many physiological parameters immediately after completing different racing distances and recovery times. However, there are no studies concerning physiological changes over shorter racing distances. We therefore assessed the effect of sprint exercise on HR, BL and RT in nine greyhounds performing sprint exercise over a 100-m distance chasing a lure. After the exercise, dogs underwent a passive 10-min recovery phase. Before the exercise, immediately after it and at 5 and 10 min during recovery, HR and RT were assessed and blood samples were collected for BL determination. HR, BL and RT values increased significantly after the exercise (P<0.01). Whereas HR returned to pre-exercise values at 10 min during the recovery phase (P>0.1), BL concentration and RT remained increased (P<0.01). The abrupt increase in HR, BL and RT values observed immediately after the exercise indicates the high intensity of the effort performed. Similarly, BL concentration after the exercise exceeded the 4 mmol/L lactate threshold, suggesting a predominant anaerobic metabolism during effort. Although HR returned to pre-exercise values 10 min after the exercise, a more extensive recovery phase would be necessary for a total return to resting values, particularly for BL and RT. In greyhounds subjected to high-intensity exercise, HR, BL and RT were reliable physiological parameters to accurately assess the physiological response to effort. The use of sprint exercises over short racing distances could be useful for appropriately monitoring fitness in sporting dogs.