{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T23:20:46Z","timestamp":1791415246067,"version":"4.3.3"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"4","funder":[{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"publisher","award":["W81XWH-16-2-0055"],"award-info":[{"award-number":["W81XWH-16-2-0055"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,8,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Leukocytosis is common after burn injury from profound systemic inflammatory response. Total leukocyte count (TLC) often decreases 72-96 h post-injury. The incidence of early (&amp;lt;72 h) leukopenia has not been previously described; this analysis sought to determine if early and extreme decreases in TLC were associated with increased fluid requirements or resuscitation-related outcomes in patients after burn injury. The burn navigator (BN) database is composed of 300 patients with &amp;gt;20% TBSA and &amp;gt;40 kg that were resuscitated utilizing the BN clinical decision support system. Patients were split into 2 groups based on a decrease in TLC from admission of greater than versus less than 15 000 cells per microliter. Demographics, resuscitation volumes, resuscitation-related complications, and 7-day survival were collected. Of the 295 patients in the analysis, patients with greater than the 15-point decrease in WBC from admission had more full-thickness burns (14.2 [2, 36]) and greater TBSA (41 [30.2, 57.4]) than those with less than a 15-point decrease (7.7 [0.3, 14.8], P &amp;lt; .001), 27.5 [23, 36], P &amp;lt; .001. Patients with greater than a 15-point WBC drop had a significantly higher incidence of admission myoglobinuria and AKI in the first 48 h even after adjusting for TBSA. Survival at 7 days did not differ (66.7% vs. 83.7%, P &amp;gt; .05) when adjusting for TBSA. A decrease in WBC of at least 15 points after admission was associated with early AKI and a significantly higher incidence of admission myoglobinuria. Future studies need to investigate the mechanism behind this association and possible early interventions.<\/jats:p>","DOI":"10.1093\/jbcr\/iraf039","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T13:54:37Z","timestamp":1744206877000},"page":"850-853","source":"Crossref","is-referenced-by-count":1,"title":["Decrease in Total Leukocyte Count is Associated with Acute Kidney Injury After Severe Burn"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4066-7331","authenticated-orcid":false,"given":"Julie A","family":"Rizzo","sequence":"first","affiliation":[{"name":"Department of Trauma, Brooke Army Medical Center , Fort Sam Houston, TX ,","place":["USA"]},{"name":"Departments of Surgery and Medicine, Uniformed Services University of Health Sciences , Bethesda, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9651-4553","authenticated-orcid":false,"given":"Jason M","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Trauma, Brooke Army Medical Center , Fort Sam Houston, TX ,","place":["USA"]},{"name":"Departments of Surgery and Medicine, Uniformed Services University of Health Sciences , Bethesda, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9365-4983","authenticated-orcid":false,"given":"James K","family":"Aden","sequence":"additional","affiliation":[{"name":"Department of Trauma, Brooke Army Medical Center , Fort Sam Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2322-5216","authenticated-orcid":false,"given":"Steven G","family":"Schauer","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology and Emergency Medicine, University of Colorado School of Medicine , Aurora, CO ,","place":["USA"]},{"name":"United States Army Institute of Surgical Research , Fort Sam Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4655-2527","authenticated-orcid":false,"given":"Jan-Michael","family":"Van Gent","sequence":"additional","affiliation":[{"name":"Department of Trauma, Brooke Army Medical Center , Fort Sam Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2978-4251","authenticated-orcid":false,"given":"Wylan C","family":"Peterson","sequence":"additional","affiliation":[{"name":"Department of Trauma, Brooke Army Medical Center , Fort Sam Houston, TX ,","place":["USA"]},{"name":"Departments of Surgery and Medicine, Uniformed Services University of Health Sciences , Bethesda, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke J","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Department of Trauma, Brooke Army Medical Center , Fort Sam Houston, TX ,","place":["USA"]},{"name":"Departments of Surgery and Medicine, Uniformed Services University of Health Sciences , Bethesda, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Salinas","sequence":"additional","affiliation":[{"name":"United States Army Institute of Surgical Research , Fort Sam Houston, TX ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6969-2648","authenticated-orcid":false,"given":"Laura S","family":"Johnson","sequence":"additional","affiliation":[{"name":"Walter L. Ingram Burn Center, Grady Memorial Hospital , Atlanta, GA ,","place":["USA"]},{"name":"Department of Surgery, Emory University School of Medicine , Atlanta, GA ,","place":["USA"]},{"name":"Department of Surgery, Morehouse School of Medicine , Atlanta, GA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,9]]},"reference":[{"key":"2025083004164877600_CIT0001","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.burns.2014.11.009","article-title":"Coagulopathy in burn patients: one part of a deadly trio","volume":"41","author":"Lavrentieva","year":"2015","journal-title":"Burns"},{"key":"2025083004164877600_CIT0002","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/BCR.0b013e3181cb8c87","article-title":"Early acute kidney injury predicts progressive renal dysfunction and higher mortality in severely burned adults","volume":"31","author":"Mosier","year":"2010","journal-title":"J Burn Care Res"},{"key":"2025083004164877600_CIT0003","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1620\/tjem.232.177","article-title":"U-shape relationship of white blood cells with acute kidney injury and mortality in critically ill patients","volume":"232","author":"Han","year":"2014","journal-title":"Tohoku J Exp Med"},{"key":"2025083004164877600_CIT0004","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/aas.13255","article-title":"Acute kidney injury after burn surgery: preoperative neutrophil\/lymphocyte ratio as a predictive factor","volume":"63","author":"Kim","year":"2019","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025083004164877600_CIT0005","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1093\/jbcr\/irab182","article-title":"Initial results of the American Burn Association observational multicenter evaluation on the effectiveness of the burn navigator","volume":"43","author":"Rizzo","year":"2022","journal-title":"J Burn Care Res"},{"key":"2025083004164877600_CIT0006","first-page":"864","article-title":"Fluid resuscitation, burn percentage, and physiologic age","volume":"19","author":"Baxter","year":"1979","journal-title":"J Trauma"},{"key":"2025083004164877600_CIT0007","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1055\/s-0030-1254051","article-title":"Disseminated intravascular coagulation in burn injury","volume":"36","author":"Lippi","year":"2010","journal-title":"Semin Thromb Hemost"},{"key":"2025083004164877600_CIT0008","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.burns.2018.09.004","article-title":"Early clinical complete blood count changes in severe burn injuries","volume":"45","author":"Sen","year":"2019","journal-title":"Burns"},{"key":"2025083004164877600_CIT0009","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1016\/j.burns.2019.07.014","article-title":"Natural kinetics of blood cells following major burn: impact of early decreases in white blood cells and platelets as prognostic markers of mortality","volume":"45","author":"Osuka","year":"2019","journal-title":"Burns"},{"key":"2025083004164877600_CIT0010","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1093\/jbcr\/irab102","article-title":"Inhalation injury is associated with endotheliopathy and abnormal fibrinolytic phenotypes in burn patients: a cohort study","volume":"43","author":"Keyloun","year":"2022","journal-title":"J Burn Care Res"},{"key":"2025083004164877600_CIT0011","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1159\/000204793","article-title":"Detection of aggregated leukocytes in the circulating pool during stress-demargination is not necessarily a result of decreased leukocyte adhesiveness","volume":"86","author":"Arber","year":"1991","journal-title":"Acta Haematol"},{"key":"2025083004164877600_CIT0012","doi-asserted-by":"crossref","first-page":"1216094","DOI":"10.3389\/fimmu.2023.1216094","article-title":"Advances in the study of B cells in renal ischemia","volume":"14","author":"Fan","year":"2023","journal-title":"Front Immunol"},{"key":"2025083004164877600_CIT0013","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1681\/ASN.2009020182","article-title":"B cells limit repair after ischemic acute kidney injury","volume":"21","author":"Jang","year":"2010","journal-title":"J Am Soc Nephrol"},{"key":"2025083004164877600_CIT0014","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/S0736-4679(99)00084-0","article-title":"Early predictors of myoglobinuria and acute renal failure following electrical injury","volume":"17","author":"Rosen","year":"1999","journal-title":"J Emerg Med"}],"container-title":["Journal of Burn Care &amp; 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