title: Association of AKI with adverse outcomes in burned military casualties.
abstract: OBJECTIVE
  Although associated with increased morbidity and mortality, AKI has not been systematically examined in military personnel injured from combat operations in Iraq and Afghanistan.
  
  
  METHODS
  Patients evacuated from Iraq and Afghanistan to a burn unit were examined. AKI was classified by the Acute Kidney Injury Network (AKIN) and Risk-Injury-Failure-Loss-End Stage (RIFLE) schemas. Age, sex, percentage of total body surface area burned (TBSA), percentage of full-thickness burn, inhalation injury, and injury severity score were recorded. Additional data that could be associated with poor outcomes were recorded for patients with TBSA ≥20%. Multivariate logistic regression analyses were performed to determine factors associated with morbidity and mortality.
  
  
  RESULTS
  AKI prevalence rates by the RIFLE and AKIN criteria were 23.8% and 29.9%, respectively. After logistic regression, RIFLE categories of risk (odds ratio [OR], 15.34; 95% confidence interval [CI], 1.75-134; P=0.01), injury (OR, 46.28; 95% CI, 5.02-427; P<0.001), and failure (OR, 126; 95% CI, 13.39->999; P<0.001); AKIN-2 (OR, 23.70; 95% CI, 2.32-242; P=0.008); and AKIN-3 (OR, 130; 95% CI, 13.38->999; P<0.001) were significantly associated with death. AKIN-3, injury, and failure remained significant in the subset of patients with ≥20% TBSA. There was also a strong interaction between TBSA and the stage of AKI with respect to ventilator and intensive care unit days.
  
  
  CONCLUSIONS
  AKI is prevalent in military casualties with burn injury and is independently associated with morbidity and mortality after adjustment for factors associated with injury severity.
authors.affiliation: San Antonio Military Medical Center, Fort Sam Houston, Texas 78234, USA. ian.stewart@us.af.mil
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Stewart
authors.forename: Molly A
authors.initials: MA
authors.lastname: Tilley
authors.forename: Casey L
authors.initials: CL
authors.lastname: Cotant
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.forename: Christopher
authors.initials: C
authors.lastname: Gisler
authors.forename: Hana K
authors.initials: HK
authors.lastname: Kwan
authors.forename: Jeffery
authors.initials: J
authors.lastname: McCorcle
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
authors.forename: Kevin K
authors.initials: KK
authors.lastname: Chung
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D000328:Adult; D055826:Afghan Campaign 2001-; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D002053:Burn Units; D002056:Burns / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D002059:Burns, Inhalation / Q000453:epidemiology; D003404:Creatinine / Q000097:blood; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States; D055815:Young Adult
chemical_list: D015415:Biomarkers; D003404:Creatinine