Faculty of Medicine, University of Toronto, Ontario, Canada.
Damos Associates Data Modelling Systems, Toronto, Ontario, Canada.
J Burn Care Res. 2021 Mar 4;42(2):126-134. doi: 10.1093/jbcr/iraa123.
Acute kidney injury (AKI) early after a major burn has not been widely studied. Our purpose was to evaluate the prevalence of and risk factors for early AKI and the effect of early AKI on outcome. Retrospective cohort study of adults with burns ≥20% TBSA admitted between November 24, 2015 and July 1, 2019. "Early AKI" occurring within 7 days of injury was identified using urine output and serum creatinine Kidney Disease International Global Outcome criteria. Multivariate regression models were developed for development of early AKI, development of AKI on day 0 or 1 postburn ("very early AKI"), and for in-hospital death. Among 85 patients, 62.4% developed early AKI, of which 26% had stage 3 AKI. Renal replacement therapy was required in 64% of stage 3 patients by day 7. Patients with early AKI were significantly older [50 (40.5-61) vs 37.5 (27.2-46.8) years, P < .001], and a significantly greater proportion was intubated in the first 24 hours postburn (90.6 vs 59.4%, P = .001). Resuscitation with high-dose vitamin C (HDVC) was independently associated with more frequent early AKI. Older age was significantly associated and HDVC was closely associated with increased very early AKI. In-hospital mortality was 37.7% for patients with early AKI. Older age, larger burn size, and development of early stage 3 AKI were independently associated with increased in-hospital death. Early AKI is common and carries a poor prognosis for survival. Resuscitation involving HDVC appears to be related to a higher likelihood of early and possibly very early AKI.
大面积烧伤后早期急性肾损伤（AKI）尚未得到广泛研究。我们的目的是评估早期 AKI 的患病率和危险因素，以及早期 AKI 对结局的影响。这是一项回顾性队列研究，纳入了 2015 年 11 月 24 日至 2019 年 7 月 1 日期间，烧伤面积≥20%TBSA 的成年患者。使用尿量和血清肌酐肾脏疾病国际全球结局标准，确定伤后 7 天内发生的“早期 AKI”。针对早期 AKI、烧伤后第 0 或 1 天发生 AKI（“极早期 AKI”）以及院内死亡，建立了多变量回归模型。在 85 例患者中，62.4%发生了早期 AKI，其中 26%为 3 期 AKI。到第 7 天，64%的 3 期患者需要进行肾脏替代治疗。发生早期 AKI 的患者年龄明显较大[50（40.5-61）比 37.5（27.2-46.8）岁，P<0.001]，伤后 24 小时内插管的比例明显更高[90.6%比 59.4%，P=0.001]。高剂量维生素 C（HDVC）复苏与更频繁的早期 AKI独立相关。高龄与 HDVC 均与极早期 AKI的发生显著相关。早期 AKI 患者的院内死亡率为 37.7%。年龄较大、烧伤面积较大以及早期 3 期 AKI 的发生与院内死亡风险增加独立相关。早期 AKI 较为常见，且与生存预后不良相关。涉及 HDVC 的复苏似乎与早期和可能极早期 AKI 的发生更相关。
