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Rat Burn Model to Study Full-Thickness Cutaneous Thermal Burn and Infection
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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.
Summary
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.
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.
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