Yoon Jaechul, Kim Youngmin, Yim Haejun, Cho Yong Suk, Kym Dohern, Hur Jun, Chun Wook, Yang Hyeong Tae
Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 94-200, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 150-719, Republic of Korea.
Department of Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 94-200, 12, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 150-719, Republic of Korea; Department of Surgery, Burn center, Hallym University Hangang Sacred Heart Hospital, 94-200, Beodeunaru-ro 7-gil, Youngdeungpo-gu, Seoul, 150-719, Republic of Korea.
Burns. 2017 Nov;43(7):1418-1426. doi: 10.1016/j.burns.2017.03.015. Epub 2017 Apr 15.
Acute kidney injury (AKI) is a critical complications in severely burned patients associated with high morbidity and mortality. The purpose of this study was to investigate the impact of severity of AKI at the time of continuous renal replacement therapy (CRRT) start on patient outcome and to identify the prognostic factors in severely burned patients with CRRT application.
From January 2007 to June 2010, 84 burn patients with more than 40% of total body surface area (TBSA) burned who treated with continuous renal replacement therapy for acute kidney injury were analyzed retrospectively.
There was no significant difference of mortality by the severity of AKI at the time of CRRT start. However, the mean TBSA burned, abbreviated burn severity index, arterial pH, partial pressure of carbon dioxide (PaCO) and blood urea nitrogen (BUN)/creatinine (Cr) ratio had a statistical significance to predict mortality in receiver operation characteristic curve. In a multivariate logistic regression analysis, only sepsis had an independent association with mortality.
The severity of the AKI at the time of CRRT start did not have significant relationship with patient outcome. CRRT can be applied to minimize the complication of AKI including electrolyte imbalance and volume overload. Because only the presence of sepsis was independently associated with mortality, treatment for sepsis should be focused to improve the survival of the severely burned patients with CRRT.
急性肾损伤（AKI）是重度烧伤患者的一种严重并发症，与高发病率和死亡率相关。本研究的目的是探讨开始持续肾脏替代治疗（CRRT）时AKI的严重程度对患者预后的影响，并确定接受CRRT治疗的重度烧伤患者的预后因素。
回顾性分析2007年1月至2010年6月期间84例烧伤面积超过40%体表面积（TBSA）且因急性肾损伤接受持续肾脏替代治疗的烧伤患者。
开始CRRT时AKI的严重程度与死亡率无显著差异。然而，在受试者工作特征曲线中，平均烧伤TBSA、简化烧伤严重程度指数、动脉pH值、二氧化碳分压（PaCO）和血尿素氮（BUN）/肌酐（Cr）比值对预测死亡率具有统计学意义。在多因素逻辑回归分析中，只有脓毒症与死亡率有独立关联。
开始CRRT时AKI的严重程度与患者预后无显著关系。CRRT可用于将包括电解质失衡和容量超负荷在内的AKI并发症降至最低。由于只有脓毒症的存在与死亡率独立相关，因此应着重治疗脓毒症以提高接受CRRT治疗的重度烧伤患者的生存率。
