Steinvall I, Bak Z, Sjoberg F
The Burn Unit, Department of Hand and Plastic Surgery, Linköping University Hospital, Garnisonsvägen, Linköping, 58185, Sweden.
Crit Care. 2008;12(5):R124. doi: 10.1186/cc7032. Epub 2008 Oct 10.
The purpose of this study was to determine the incidence, time course, and outcome of acute kidney injury after major burns and to evaluate the impact of possible predisposing factors (age, gender, and depth and extent of injury) and the relation to other dysfunctioning organs and sepsis.
We performed an explorative cohort study on patients with a TBSA% (percentage burned of total body surface area) of 20% or more who were admitted to a national burn centre. Acute kidney injury was classified according to the international consensus classification of RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Prospectively collected clinical and laboratory data were used for assessing organ dysfunction, systemic inflammatory response, and sepsis.
The incidence of acute kidney injury among major burns was 0.11 per 100,000 people per year. Of 127 patients, 31 (24%) developed acute kidney injury (12% Risk, 8% Injury, and 5% Failure). Mean age was 40.6 years (95% confidence interval [CI] 36.7 to 44.5), TBSA% was 38.6% (95% CI 35.5% to 41.6%), and 25% were women. Mortality was 14% and increased with increasing RIFLE class (7% normal, 13% Risk, 40% Injury, and 83% Failure). Renal dysfunction occurred within 7 days in 55% of the patients and recovered among all survivors. Age, TBSA%, and extent of full thickness burns were higher among the patients who developed acute kidney injury. Pulmonary dysfunction and systemic inflammatory response syndrome were present in all of the patients with acute kidney injury and developed before the acute kidney injury. Sepsis was a possible aggravating factor in acute kidney injury in 48%. Extensive deep burns (25% or more full thickness burn) increased the risk for developing acute kidney injury early (risk ratio 2.25).
Acute kidney injury is common, develops soon after the burn, and parallels other dysfunctioning organs. Although acute kidney injury recovered in all survivors, in higher acute kidney injury groups, together with cardiovascular dysfunction, it correlated with mortality.
本研究旨在确定严重烧伤后急性肾损伤的发病率、病程及转归，并评估可能的诱发因素（年龄、性别、损伤深度和范围）的影响以及与其他功能障碍器官和脓毒症的关系。
我们对一家国家烧伤中心收治的全身烧伤面积（TBSA%）达20%或更高的患者进行了一项探索性队列研究。急性肾损伤根据RIFLE（风险、损伤、衰竭、肾功能丧失和终末期肾病）国际共识分类进行分类。前瞻性收集的临床和实验室数据用于评估器官功能障碍、全身炎症反应和脓毒症。
严重烧伤患者中急性肾损伤的发病率为每年每10万人中有0.11例。在127例患者中，31例（24%）发生了急性肾损伤（12%为风险期，8%为损伤期，5%为衰竭期）。平均年龄为40.6岁（95%置信区间[CI]为36.7至44.5），TBSA%为38.6%（95%CI为35.5%至41.6%），25%为女性。死亡率为14%，且随RIFLE分级升高而增加（正常7%，风险期13%，损伤期40%，衰竭期83%）。55%的患者在7天内出现肾功能障碍，所有幸存者均康复。发生急性肾损伤的患者年龄、TBSA%和全层烧伤范围更高。所有急性肾损伤患者均存在肺功能障碍和全身炎症反应综合征，且在急性肾损伤之前出现。脓毒症在48%的急性肾损伤患者中可能是加重因素。广泛深度烧伤（全层烧伤25%或更多）增加了早期发生急性肾损伤的风险（风险比2.25）。
急性肾损伤很常见，烧伤后很快发生，且与其他功能障碍器官平行。虽然所有幸存者的急性肾损伤均康复，但在急性肾损伤程度较高的组中，与心血管功能障碍一起，它与死亡率相关。
