Firefighters Burn Center, Regional One Health, Memphis, Tennessee, USA,
United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA.
Blood Purif. 2021;50(4-5):473-480. doi: 10.1159/000512101. Epub 2020 Dec 2.
Acute kidney injury (AKI) is associated with high mortality in burn patients. Previously, we reported that timely initiation of renal replacement therapy (RRT) with an individualized preference toward continuous modes at relatively higher than recommended doses has become standard practice in critically ill burn patients with AKI and is associated with a historically low mortality. The purpose of this cohort analysis was to determine if modality choice impacted survival in burn patients.
After Institutional Review Board approval, a subset analysis was performed on de-identified data collected during a multicenter, observational study. All patients (n = 170) were 18 years or older, admitted with severe burn injuries and started on RRT. Comparisons were made utilizing χ2 or Fisher's exact test. Kaplan-Meier plots were utilized to assess survival. Sample size determinations to aid future research were calculated utilizing χ2 test with a Yates Correction Factor.
Demographics and revised Baux were similar between groups. When continuous venovenous hemofiltration (CVVH) was compared to all other modalities, there was no statistically significant difference in survival (56 vs. 43%, p = 0.124). However, survival was significantly improved (54 vs. 37%, p = 0.032) in the subset of patients requiring vasopressors (n = 77). There was no statistically significant survival difference in patients with inhalation injury (38 vs. 29%, p = 0.638) or acute lung injury/acute respiratory distress syndrome (51 vs. 33%, p = 0.11).
DISCUSSION/CONCLUSION: Survival may be improved if CVVH is chosen as the preferred modality in burn patients with shock and requiring RRT. Differences in other subsets were promising, but analysis was underpowered. Further research should determine if modality choice provides survival benefit in any other subset of burn injury.
急性肾损伤（AKI）与烧伤患者的高死亡率相关。此前，我们报道过，在伴有 AKI 的危重症烧伤患者中，及时开始肾脏替代治疗（RRT），并根据个人偏好选择连续模式，且剂量高于推荐剂量，已成为标准治疗方法，其死亡率也创历史新低。本队列分析旨在确定模式选择是否会影响烧伤患者的生存。
在获得机构审查委员会批准后，我们对一项多中心观察性研究中收集的已去识别数据进行了亚组分析。所有患者（n=170）年龄均≥18 岁，因严重烧伤入院并开始接受 RRT。利用 χ2 或 Fisher 确切检验进行比较。利用 Kaplan-Meier 图评估生存。利用 χ2 检验（带 Yates 校正因子）计算了辅助未来研究的样本量。
两组患者的人口统计学特征和修订的 Baux 评分相似。与所有其他模式相比，连续性静脉-静脉血液滤过（CVVH）在生存方面无统计学差异（56%比 43%，p=0.124）。然而，在需要血管加压药的患者亚组（n=77）中，生存显著改善（54%比 37%，p=0.032）。在吸入性损伤患者（38%比 29%，p=0.638）或急性肺损伤/急性呼吸窘迫综合征患者（51%比 33%，p=0.11）中，生存无统计学差异。
讨论/结论：如果休克且需要 RRT 的烧伤患者选择 CVVH 作为首选模式，生存可能会得到改善。其他亚组的差异很有希望，但分析的效能不足。进一步的研究应确定在任何其他烧伤损伤亚组中，模式选择是否能提供生存获益。
