Julia Kleinhapl, MD: No financial relationships to disclose
Background: Burns are a severe form of trauma and frequently result in acute critical illness, multi-organ dysfunction, and shock. Substantial fluid resuscitation and pharmacological interventions may independently increase the risk of renal injury. Acute renal complications after burn are well recognized; long-term renal morbidity and associated risk profiles remain poorly characterized.
Methods: The real-world TriNetX database was queried for burn patients of all ages using ICD-10 codes T20-T25 and T30-T32. Patients who developed shock (ICD-10: R57) within one month after burn were compared to burn patients without shock. Propensity score matching was performed for demographics, percentage of TBSA burned, and relevant metabolic, cardiovascular, malignant, and renal comorbidities. Acute and subacute renal outcomes assessed within 3 months included acute kidney injury (AKI), acute cortical necrosis, thrombotic microangiopathy, kidney infarction or ischemia, renal vein thrombosis, renal artery thrombosis, dialysis requirement, and mortality. Long-term outcomes assessed at 1 year included newly diagnosed chronic kidney disease (CKD), dialysis requirement, and mortality. Results are presented as risk ratios (RR) with 95% confidence intervals (CI) and Kaplan-Meier survival analyses with log-rank testing.
Outcome: Among 917,644 burn patients, 15,731 (1.7%) developed shock. Patients with shock were predominantly male (58%), had a mean age of 56.8 ± 18.7 years, and had high burdens of diabetes (41%), ischemic heart disease (40%), hypertension (64%), and chronic kidney disease (26%). Shock etiology was specified as cardiogenic in 26% and hypovolemic in 28%, with the remaining cases coded as unspecified shock. After 1:1 propensity score matching, both cohorts included 15,500 patients. At 3 months, burn patients with shock had significantly lower survival (73.65% vs. 97.41%, p< 0.0001), higher risk of AKI (RR 3.43; 95% CI 2.84–4.15), and increased dialysis requirement (RR 12.26; 95% CI 9.94–15.12). At 1 year, survival probability remained lower in burn patients with shock (66.07% vs. 94.11%, p< 0.0001), with a higher risk of newly diagnosed CKD (RR 1.46; 95% CI 1.29–1.67) and dialysis requirement at 1 year (RR 15.96; 95% CI 12.65–20.14). Renal vascular and parenchymal complications were rare and occurred in fewer than 10 patients per outcome group.
Conclusion: Shock in burn patients is rare but predominantly affects middle-aged men with high-risk comorbidity profiles. Cardiogenic shock occurred nearly as often as hypovolemic shock. Although renal vascular complications were uncommon, burn-associated shock was linked to markedly reduced survival and increased risks of acute and chronic kidney impairment, including dialysis requirement.
