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Decrease in Total Leukocyte Count is Associated with Acute Kidney Injury After Severe Burn.

Julie A Rizzo1,2, Jason M Thomas1,2, James K Aden1

  • 1Department of Trauma, Brooke Army Medical Center, Fort Sam Houston, TX, USA.

Journal of Burn Care & Research : Official Publication of the American Burn Association
|April 9, 2025
PubMed
Summary
This summary is machine-generated.

A significant drop in white blood cell count (WBC) after burn injury may signal increased risk for acute kidney injury (AKI) and myoglobinuria. This early leukopenia, though not impacting 7-day survival, warrants further investigation for timely interventions.

Keywords:
acute kidney injuryburnleukopeniamyoglobinuria

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Area of Science:

  • Trauma and Burn Critical Care
  • Renal Medicine
  • Hematology

Background:

  • Leukocytosis is a common response to burn injury due to systemic inflammation.
  • While a decrease in total leukocyte count (TLC) is typical 72-96 hours post-burn, early leukopenia (<72 hours) is not well-described.
  • Understanding early changes in TLC may reveal associations with resuscitation needs and outcomes.

Purpose of the Study:

  • To determine if early, extreme decreases in total leukocyte count (TLC) after burn injury are associated with increased fluid resuscitation requirements.
  • To investigate the relationship between early TLC decrease and resuscitation-related complications, including acute kidney injury (AKI) and myoglobinuria.
  • To assess the association between early TLC decrease and 7-day survival in burn patients.

Main Methods:

  • Analysis of 295 burn patients (>20% TBSA, >40kg) from the Burn Navigator database, resuscitated using a clinical decision support system.
  • Patients were stratified into two groups based on a decrease in TLC from admission: >15,000 cells/µL versus <15,000 cells/µL.
  • Data collected included demographics, resuscitation volumes, complications (myoglobinuria, AKI), and 7-day survival, with adjustments for TBSA.

Main Results:

  • Patients with a >15,000 cells/µL decrease in TLC had significantly higher rates of full-thickness burns and greater TBSA.
  • A >15,000 cells/µL drop in TLC was associated with a significantly higher incidence of admission myoglobinuria and AKI within 48 hours, even after TBSA adjustment.
  • Seven-day survival did not significantly differ between the groups when adjusted for TBSA.

Conclusions:

  • An early decrease in white blood cell count (WBC) of at least 15,000 cells/µL post-admission in burn patients is linked to early AKI and increased myoglobinuria.
  • This association between early leukopenia and adverse outcomes like AKI and myoglobinuria warrants further investigation.
  • Future research should explore the underlying mechanisms and potential early interventions for this observed association.