Renal impairment after burn-associated shock

Burn injury is frequently complicated by shock, critical illness, and multi-organ dysfunction, all of which may contribute to renal injury. While acute renal complications are well recognized, long-term renal outcomes remain incompletely characterized.

The TriNetX global network was queried for adult burn patients who developed shock within 7 days of injury using ICD-10-CM codes. Patients were propensity score-matched 1:1 for demographics, comorbidities, burn characteristics, mechanical ventilation, and ICU admission to burn patients without shock. Outcomes included acute kidney injury (AKI), chronic kidney disease (CKD), renal replacement therapy (RRT), acute cortical necrosis, thrombotic microangiopathy, renal vascular complications, and mortality. Among patients with shock, those who developed AKI within 3 months were compared with shock patients without AKI for cardiovascular, thrombotic, neurologic, and mortality outcomes from 3-12 months after burn. Kaplan-Meier analyses were performed for survival.

Among 657,605 adult burn patients, 6.6% developed shock within 7 days. After matching (36,317 patients per cohort), shock was associated with significantly higher 3-month mortality (2.10% vs. 0.81%; RR 2.60; 95% CI 2.26-2.99; p<0.0001), AKI (0.90% vs. 0.54%; RR 1.65; 95% CI 1.36-1.99; p<0.0001), and RRT (0.29% vs. 0.07%; RR 4.42; 95% CI 2.78-7.04; p<0.0001). One-year mortality (3.46% vs. 2.17%; RR 1.60; 95% CI 1.46-1.75) and long-term RRT (0.40% vs. 0.11%; RR 3.59; 95% CI 2.53-5.09) remained significantly increased (both p<0.0001). Among patients with shock, AKI was associated with increased mortality.

Burn-associated shock was associated with increased risks of AKI, RRT, and mortality, supporting enhanced renal surveillance and kidney-protective strategies in burn patients complicated by shock.