Kim Gheun-Ho, Oh Kook Hwan, Yoon Jong Woo, Koo Ja-Wyong, Kim Hyung Jik, Chae Dong-Wan, Noh Jung Woo, Kim Jong Hyun, Park Yoon Kyu
Department of Internal Medicine, Hallym University College of Medicine, Kangwon Do, South Korea.
Am J Nephrol. 2003 Jan-Feb;23(1):55-60. doi: 10.1159/000066299.
Acute renal failure (ARF) is not a rare occurrence in severe burns and is an important complication leading to an increase in mortality. The severity of the burn is largely determined by the burn size, and severe burns are likely to cause enough loss of extracellular fluid and albumin from plasma volume to produce shock and hypoalbuminemia.
We hypothesized that initial serum albumin level may be useful as an indicator of prognosis and severity of injury in burned patients.
The clinical characteristics of 147 adult patients with second- and third-degree burns covering 30% or more of their body surface area were analyzed retrospectively. Logistic regression was used to estimate the relative risks of ARF and mortality associated with the larger burn size and the lower serum albumin level at admission.
Mean burned body surface was 60.0 +/- 21.8% (range 30-100%). Twenty-eight (19.0%) out of 147 patients experienced ARF, defined as a serum creatinine > or = 2 mg/dl, during the admission. The patients with ARF had larger burn size (79.5 +/- 15.4 vs. 55.3 +/- 20.5%, p < 0.0001) and lower serum albumin concentration at admission (1.92 +/- 0.66 vs. 2.48 +/- 0.82 g/dl, p < 0.0005) compared with those without ARF. All patients with ARF expired, whereas 29.4% (35/119) of the patients without ARF died. The burn size > or = 65% was associated with a risk of ARF that was 9.9 times and with a risk of death that was 14.2 times as high as that for the burn size <65%. The initial serum albumin level <2.5 g/dl was associated with a risk of death that was 2.7 times as high as that for the initial serum albumin level > or = 2.5 g/dl.
When major burns are complicated by ARF, the mortality rate increases significantly. Burn size is an independent predictor of ARF occurring in major burns. Initially depressed serum albumin level is associated with an increase in mortality in the major burn patients.
急性肾衰竭（ARF）在严重烧伤中并不罕见，是导致死亡率升高的重要并发症。烧伤的严重程度很大程度上由烧伤面积决定，严重烧伤很可能导致细胞外液和血浆白蛋白大量丢失，从而引发休克和低白蛋白血症。
我们假设初始血清白蛋白水平可能作为烧伤患者预后和损伤严重程度的一个指标。
回顾性分析147例成人二度和三度烧伤面积达30%及以上患者的临床特征。采用逻辑回归分析来评估入院时较大烧伤面积和较低血清白蛋白水平与ARF及死亡率相关的相对风险。
平均烧伤体表面积为60.0±21.8%（范围30 - 100%）。147例患者中有28例（19.0%）在入院期间发生ARF，定义为血清肌酐≥2mg/dl。与未发生ARF的患者相比，发生ARF的患者烧伤面积更大（79.5±15.4对55.3±20.5%，p<0.0001），入院时血清白蛋白浓度更低（1.92±0.66对2.48±0.82g/dl，p<0.0005）。所有发生ARF的患者均死亡，而未发生ARF的患者中有29.4%（35/119）死亡。烧伤面积≥65%与ARF风险相关，是烧伤面积<65%患者的9.9倍，与死亡风险相关，是其14.2倍。初始血清白蛋白水平<2.5g/dl与死亡风险相关，是初始血清白蛋白水平≥2.5g/dl患者的2.7倍。
严重烧伤并发ARF时，死亡率显著增加。烧伤面积是严重烧伤发生ARF的独立预测因素。初始血清白蛋白水平降低与严重烧伤患者死亡率增加相关。
