Clark Audra T, Li Xilong, Kulangara Rohan, Adams-Huet Beverley, Huen Sarah C, Madni Tarik D, Imran Jonathan B, Phelan Herb A, Arnoldo Brett D, Moe Orson W, Wolf Steven E, Neyra Javier A
Department of Surgery, Division of Burn, Trauma, and Critical Care, University of Texas Southwestern Medical Center, Dallas, Texas.
Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
J Burn Care Res. 2019 Jan 1;40(1):72-78. doi: 10.1093/jbcr/iry046.
Acute kidney injury (AKI) is a common and morbid complication in patients with severe burn. The reported incidence of AKI and mortality in this population varies widely due to inconsistent and changing definitions. They aimed to examine the incidence, severity, and hospital mortality of patients with AKI after burn using consensus criteria. This is a retrospective cohort study of adults with thermal injury admitted to the Parkland burn intensive care unit (ICU) from 2008 to 2015. One thousand forty adult patients with burn were admitted to the burn ICU. AKI was defined by KDIGO serum creatinine criteria. Primary outcome includes hospital death and secondary outcome includes length of mechanical ventilation, ICU, and hospital stay. All available serum creatinine measurements were used to determine the occurrence of AKI during the hospitalization. All relevant clinical data were collected. The median total body surface area (TBSA) of burn was 16% (IQR: 6%-29%). AKI occurred in 601 patients (58%; AKI stage 1, 60%; stage 2, 19.8%; stage 3, 10.5%; and stage 3 requiring renal replacement therapy [3-RRT], 9.7%). Patients with AKI had larger TBSA burn (median 20.5% vs 11.0%; P < .001) and more mechanical ventilation and hospitalization days than patients without AKI. The hospital death rate was higher in those with AKI vs those without AKI (19.7% vs 3.9%; P < .001) and increased by each AKI severity stage (P trend < .001). AKI severity was independently associated with hospital mortality in the small burn group (for TBSA ≤ 10%: stage 1 adjusted OR 9.3; 95% CI, 2.6-33.0; stage 2-3 OR, 35.0; 95% CI, 9.0-136.8; stage 3-RRT OR, 30.7; 95% CI, 4.2-226.4) and medium burn group (TBSA 10%-40%: stage 2-3 OR, 6.5; 95% CI, 1.9-22.1; stage 3-RRT OR, 35.1; 95% CI, 8.2-150.3). AKI was not independently associated with hospital death in the large burn group (TBSA > 40%). Urine output data were unavailable. AKI occurs frequently in patients after burn. Presence of and increasing severity of AKI are associated with increased hospital mortality. AKI appears to be independently and strongly associated with mortality in patients with TBSA ≤ 40%. Further investigation to develop risk-stratification tools tailoring this susceptible population is direly needed.
急性肾损伤（AKI）是重度烧伤患者常见且严重的并发症。由于定义不一致且不断变化，该人群中AKI的报告发病率和死亡率差异很大。他们旨在使用共识标准检查烧伤后AKI患者的发病率、严重程度和医院死亡率。这是一项对2008年至2015年入住帕克兰烧伤重症监护病房（ICU）的成年热损伤患者的回顾性队列研究。1040名成年烧伤患者入住烧伤ICU。AKI根据KDIGO血清肌酐标准定义。主要结局包括医院死亡，次要结局包括机械通气时间、ICU住院时间和医院住院时间。所有可用的血清肌酐测量值用于确定住院期间AKI的发生情况。收集了所有相关临床数据。烧伤的中位总体表面积（TBSA）为16%（四分位间距：6%-29%）。601名患者发生AKI（58%；AKI 1期，60%；2期，19.8%；3期，10.5%；3期需要肾脏替代治疗[3-RRT]，9.7%）。与未发生AKI的患者相比，发生AKI的患者烧伤TBSA更大（中位值20.5%对11.0%；P<.001），机械通气和住院天数更多。发生AKI的患者医院死亡率高于未发生AKI的患者（19.7%对3.9%；P<.001），且随AKI严重程度阶段增加而升高（P趋势<.001）。在小面积烧伤组（TBSA≤10%）中，AKI严重程度与医院死亡率独立相关（1期调整后OR 9.3；95%CI，2.6-33.0；2-3期OR，35.0；95%CI，9.0-136.8；3期-RRT OR，30.7；95%CI，4.2-226.4）和中面积烧伤组（TBSA 10%-40%：2-3期OR，6.5；95%CI，1.9-22.1；3期-RRT OR，35.1；95%CI，8.2-150.3）。大面积烧伤组（TBSA>40%）中AKI与医院死亡无独立相关性。尿量数据不可用。烧伤后患者中AKI频繁发生。AKI的存在及其严重程度增加与医院死亡率增加相关。对于TBSA≤40%的患者，AKI似乎与死亡率独立且强烈相关。迫切需要进一步研究以开发针对这一易感人群的风险分层工具。
