Yoon Jaechul, Kim Youngmin, Kym Dohern, Hur Jun, Yim Haejun, Cho Yong-Suk, Chun Wook
Department of Surgery and Critical Care, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University Medical Center, Youngdeungpo-gu, Seoul, Korea.
PLoS One. 2017 Nov 30;12(11):e0189057. doi: 10.1371/journal.pone.0189057. eCollection 2017.
Continuous renal replacement therapy (CRRT) is administered to critically ill patients with renal injuries as renal replacement or renal support. We aimed to identify predictors of mortality among burn patients receiving CRRT, and to investigate clinical differences according to acute kidney injury (AKI) status. This retrospective observational study evaluated 216 Korean burn patients who received CRRT at a burn intensive care unit. Patients were categorized by AKI status. Data were collected regarding arterial pH, laboratory results, ratio of arterial oxygen partial pressure to fractional inspired oxygen (PF ratio), and urine production. Among surviving patients, CRRT duration and the sequential organ failure assessment score were 6.5 days and 4.7 in the non-AKI group and 23.4 days and 7.4 in the AKI group, respectively (p = 0.003 and p = 0.008). On logistic regression analyses, mortality was significantly associated with a pH of <7.2 (p = 0.004), potassium levels of >5.0 mEg/L (p = 0.045), creatinine levels of >2.0 mg/dL (p = 0.011), lactate levels of >2 mmol/L (p<0.001), a PF ratio of <200 (p = 0.042), and a platelet count of <100,000/μL (p<0.001). In the AKI group, poor outcomes were associated with a pH of <7.2, potassium levels of <5.0 mEg/L, lactate levels of >2 mmol/L, and a platelet count of <100,000/μL, while good outcomes were associated with creatinine levels of >2 mg/dL. In the non-AKI group, poor outcomes were associated with lactate levels of >1.5 mmol/L, a PF ratio of <200, and a platelet count of <100,000/μL, while good outcomes were associated with creatinine levels of >1.2 mg/dL. Duration of the CRRT application and the requirement for either renal replacement or renal support at the initiation of CRRT application are important considerations depending on its application.
连续性肾脏替代治疗（CRRT）应用于有肾损伤的危重症患者，作为肾脏替代或肾脏支持治疗。我们旨在确定接受CRRT的烧伤患者的死亡预测因素，并根据急性肾损伤（AKI）状态调查临床差异。这项回顾性观察性研究评估了216例在烧伤重症监护病房接受CRRT的韩国烧伤患者。患者根据AKI状态进行分类。收集了有关动脉pH值、实验室检查结果、动脉血氧分压与吸入氧分数之比（PF比值）和尿量的数据。在存活患者中，非AKI组的CRRT持续时间和序贯器官衰竭评估评分分别为6.5天和4.7，AKI组分别为23.4天和7.4（p = 0.003和p = 0.008）。逻辑回归分析显示，死亡率与pH值<7.2（p = 0.004）、血钾水平>5.0 mEq/L（p = 0.045）、肌酐水平>2.0 mg/dL（p = 0.011）、乳酸水平>2 mmol/L（p<0.001）、PF比值<200（p = 0.042）和血小板计数<100,000/μL（p<0.001）显著相关。在AKI组中，不良预后与pH值<7.2、血钾水平<5.0 mEq/L、乳酸水平>2 mmol/L和血小板计数<100,000/μL相关，而良好预后与肌酐水平>2 mg/dL相关。在非AKI组中，不良预后与乳酸水平>1.5 mmol/L、PF比值<200和血小板计数<100,000/μL相关，而良好预后与肌酐水平>1.2 mg/dL相关。根据CRRT的应用情况，CRRT的应用持续时间以及在开始应用CRRT时对肾脏替代或肾脏支持的需求是重要的考虑因素。
