Kidney failure trajectories and sub phenotypes in severe burn patients - 28/02/26
, Zoe Bellas d, Thaïs Walter b, d, Alexandru Cupaciu d, Maxime Coutrot d, Emmanuel Dudoignon b, d, Lucie Guillemet d, Maïté Chaussard d, Alexandre Pharaboz d, Chiheb Ben Maaouia d, Marc Chaouat e, Benoit Plaud b, d, Alexandre Mebazaa b, d, Benjamin Deniau b, d, François Dépret b, dGraphical abstract |
Highlights |
• | Primary AKI is the most frequent and lethal renal complication in burn patients, link to early severity and resuscitation requirements. |
• | Among primary AKI, a third died within 7 days, a third had secondary injury and got back to baseline sCr. |
• | Secondary renal injury is common among survivors and is often linked to infection and hemorrhagic complications. |
• | Secondary AKI relates to surgery or cardiac support and baseline hypertension, while AKD lins to vascular disease and respiratory failure. |
Abstract |
Background |
Acute kidney injury (AKI) is a common and severe complication in burn patients, significantly increasing morbidity and mortality. Recent classifications distinguish acute kidney disease (AKD) as persistent kidney dysfunction beyond seven days; however, its trajectory in burn patients remains poorly understood. This study aimed to identify renal injury phenotypes in critically ill burn patients and assess their associations with clinical outcomes.
Methods |
We conducted a single-center retrospective cohort study from 2013 to 2023 of adult (>18 years) ICU burn patients with total burn surface area >15%. Renal injury was classified using KDIGO serum creatinine criteria and renal replacement therapy needs. AKI was defined as occurring within 7 days of injury, secondary AKI as occurring beyond day 7 but lasting <7 days, and AKD as dysfunction persisting >7 days. Phenotype classification was supported by stepwise logistic regression, XGBoost, and random forest analyses.
Results |
Among 733 patients, 158 (21.6%) developed primary AKI, and overall mortality in this group was 95/158 (60.1%). Of the 121 primary AKI survivors, 58 (45.7%) developed further renal injury: secondary AKI alone (16.5%), AKD alone (10.7%), or both (20.7%). Secondary AKI and AKD were associated with mortality rates of 39% and 41%, and were independently linked to increased mortality. Primary AKI was mainly driven by baseline patient vulnerability (dementia, smoke inhalation, chronic alcohol use, age) and burn severity (TBSA full thickness, SAPS II), with dementia, hydroxocobalamin treatment, and smoke inhalation showing the strongest associations. In contrast, secondary AKI and AKD were characterized by complications occurring during ICU stay, particularly infection, cardiovascular support, digestive bleeding, and organ failures, with infection emerging as the dominant predictor across both phenotypes.
Conclusion |
Primary AKI represents the most severe renal complication post-burn, while secondary injuries reflect later complications such as infection, hemorrhagic complications, or ARDS.
Le texte complet de cet article est disponible en PDF.Keywords : Acute kidney injury, Acute kidney disease, Non-renal recovery, Burn
Plan
Vol 45 - N° 4
Article 101696- juillet 2026 Retour au numéro
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