202 Risk Factors and Outcomes of Renal Injury in Patients with a Major Burn: An Historical Cohort Study
Bibliographic record
Abstract
Renal failure in major burn patients is associated with high mortality, reported at up to 80% in recent literature. Quality Improvement work at our center suggests recent mortality in this cohort is lower than reported. Our paper investigates the associated factors and mortality rate in major burn patients with AKI. We performed a historical cohort study of burn patients admitted to our Intensive Care Unit between 2010 and 2016. Patients were excluded if there was prior history of kidney disease. Data was collected from patient charts, electronic medical records, and the ICU research database. Baseline and demographic information, as well as laboratory and clinical information regarding course and management in hospital was collected. We used multiple fractional polynomial regression to model the association between risk factors and the development of AKI. Of the 151 patients included, 64 people develop AKI (42%) as defined by the Acute Kidney Injury Network (AKIN) criteria with the following stages: AKIN stage 1 (33 of 151 [22%]), AKIN stage 2 (11 of 151 [7%]) and AKIN stage 3 (20 of 151 [13%]).Of these, 27 patients required renal replacement therapy (RRT). On multivariable regression, age per 10 year increase (OR 1.8, 95%CI: 1.2 - 2.5), APACHE II score (OR 1.2, 95%CI: 1.1 - 1.3), and TBSA% (log TBSA OR 2.7, 95% CI: 1.5 - 4.7) were all associated with the risk of developing AKI. The relationship between TBSA and development of AKI was found to have a logarithmic association (see figure). Major burn injury patients who develop AKI in our cohort had a significantly lower mortality than that reported in the literature. Additionally, we identify a potential new relationship between TBSA% and risk of AKI development, following a logarithmic pattern with highest increase in risk for a given increase in TBSA occurring before 30% TBSA. This could change the estimation of prognosis of patients with major burns who develop renal failure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".