You Bo, Yang Zichen, Zhang Yulong, Chen Yu, Gong Yali, Chen Yajie, Chen Jing, Yuan Lili, Luo Gaoxing, Peng Yizhi, Yuan Zhiqiang
Department of Burn and Plastic Surgery, No. 958 Hospital of PLA Army, Third Military Medical University (Army Medical University), Chongqing, China.
State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Front Surg. 2022 May 2;9:842999. doi: 10.3389/fsurg.2022.842999. eCollection 2022.
Acute kidney injury (AKI) is a morbid complication and the main cause of multiple organ failure and death in severely burned patients. The objective of this study was to explore epidemiology, risk factors, and outcomes of AKI for severely burned patients.
This retrospective study was performed with prospectively collected data of severely burned patients from the Institute of Burn Research in Southwest Hospital during 2011-2017. AKI was diagnosed according to Kidney Disease Improving Global Outcomes (KDIGO) criteria (2012), and it was divided into early and late AKIs depending on its onset time (within the first 3 days or >3 days post burn). The baseline characteristics, clinical data, and outcomes of the three groups (early AKI, late AKI and non-AKI) were compared using logistic regression analysis. Mortality predictors of patients with AKI were assessed.
A total of 637 adult patients were included in analysis. The incidence of AKI was 36.9% (early AKI 29.4%, late AKI 10.0%). Multiple logistic regression analysis revealed that age, gender, total burn surface area (TBSA), full-thickness burns of TBSA, chronic comorbidities (hypertension or/and diabetes), hypovolemic shock of early burn, and tracheotomy were independent risk factors for both early and late AKIs. However, sepsis was only an independent risk factor for late AKI. Decompression escharotomy was a protective factor for both AKIs. The mortality of patients with AKI was 32.3% (early AKI 25.7%, late AKI 56.3%), and that of patients without AKI was 2.5%. AKI was independently associated with obviously increased mortality of severely burned patients [early AKI, OR = 12.98 (6.08-27.72); late AKI, OR = 34.02 (15.69-73.75)]. Compared with patients with early AKI, patients with late AKI had higher 28-day mortality (34.9% vs. 19.4%, = 0.007), 90-day mortality (57.1% vs. 27.4%, < 0.0001).
AKI remains prevalent and is associated with high mortality in severely burned patients. Late-onset acute kidney injury had greater severity and worse prognosis.
急性肾损伤（AKI）是重度烧伤患者的一种严重并发症，也是多器官功能衰竭和死亡的主要原因。本研究的目的是探讨重度烧伤患者AKI的流行病学、危险因素及预后情况。
本回顾性研究采用前瞻性收集的2011年至2017年期间西南医院烧伤研究所重度烧伤患者的数据。根据改善全球肾脏病预后组织（KDIGO）（2012年）标准诊断AKI，并根据其发病时间（烧伤后前3天内或>3天）分为早期和晚期AKI。采用逻辑回归分析比较三组（早期AKI、晚期AKI和非AKI）的基线特征、临床数据及预后情况。评估AKI患者的死亡预测因素。
共纳入637例成年患者进行分析。AKI的发生率为36.9%（早期AKI为29.4%，晚期AKI为10.0%）。多因素逻辑回归分析显示，年龄、性别、烧伤总面积（TBSA）、TBSA的全层烧伤、慢性合并症（高血压或/和糖尿病）、烧伤早期的低血容量性休克及气管切开术是早期和晚期AKI的独立危险因素。然而，脓毒症仅是晚期AKI的独立危险因素。焦痂切开减压术是两种AKI的保护因素。AKI患者的死亡率为32.3%（早期AKI为25.7%，晚期AKI为56.3%），非AKI患者的死亡率为2.5%。AKI与重度烧伤患者死亡率显著增加独立相关[早期AKI，OR = 12.98（6.08 - 27.72）；晚期AKI，OR = 34.02（15.69 - 73.75）]。与早期AKI患者相比，晚期AKI患者的28天死亡率更高（34.9%对19.4%，P = 0.007），90天死亡率更高（57.1%对27.4%，P < 0.0001）。
AKI在重度烧伤患者中仍然普遍存在，且与高死亡率相关。迟发性急性肾损伤病情更严重，预后更差。
