Wandabwa Joel, Kalyesubula Robert, Najjingo Irene, Nalunjogi Joanitah, Ssekitooleko Badru, Mbiine Ronald, Alenyo Rose
Department of Surgery, Makerere University, College of Health Sciences Kampala, Uganda.
Department of Internal Medicine and Department of Physiology, Makerere University, College of Health Sciences Kampala, Uganda.
Int J Burns Trauma. 2022 Jun 15;12(3):131-138. eCollection 2022.
Acute Kidney Injury (AKI) is associated with increased mortality among severely burned patients. According to World Health Organization (WHO) 11 million people suffer from burns worldwide and burns contribute to 180,000 deaths yearly. Majority of these burns occur in the Low and Middle-Income Countries. Currently there is no published data on the incidence, risk factors and outcomes of AKI among patients with severe burns in Uganda. Early screening and treatment of patients at risk of developing AKI has been shown to improve survival. We therefore carried out a study to determine the incidence and risk factors of AKI in Uganda.
This was a prospective cohort study that consecutively included patients with severe burns admitted in Mulago National Referral Hospital burns unit between February and May 2018. Patients were followed up for 14 days and AKI was assessed according to the KIDGO criteria. The incidence of AKI was expressed as a proportion. Kaplan Meier graph was used to estimate the median survival of patients with or without AKI. The risk factors for AKI were assessed using cox proportion hazard regression analysis.
Of the 147 patients screened, 92 met the inclusion criteria but 2 declined to participate in the study. Of the study participants, 48 (53.3%) were male, 47 (52.2%) were aged 3 years and below, the median TBSA was 17 (IQR; 13-23), 58 (69.9%) had low albumin levels and 16 (18.6%) had inhalation burns. The incidence of AKI was found to be 34.4% (95% CI; 25.9-45.9) with a mortality of 11.76% (95% CI; 6.37-20.73). Total burn surface area HR=3.10 (95% CI; 1.39 to 6.94 P=0.003) was the only independent risk factor for AKI.
The incidence and mortality rate of AKI in patients with severe burns was found to be high. Having burns greater than 18% TBSA was an independent risk factor for AKI. Therefore, patients with burns greater than 18% should be assessed regularly for AKI so that treatment is instituted early should it occur.
急性肾损伤（AKI）与重度烧伤患者死亡率增加相关。据世界卫生组织（WHO）统计，全球有1100万人遭受烧伤，每年因烧伤导致18万人死亡。这些烧伤大多发生在低收入和中等收入国家。目前，乌干达重度烧伤患者中AKI的发病率、危险因素及预后尚无公开数据。对有发生AKI风险的患者进行早期筛查和治疗已被证明可提高生存率。因此，我们开展了一项研究以确定乌干达AKI的发病率和危险因素。
这是一项前瞻性队列研究，连续纳入2018年2月至5月在穆拉戈国家转诊医院烧伤科住院的重度烧伤患者。对患者进行14天的随访，并根据改善全球肾脏病预后组织（KIDGO）标准评估AKI。AKI的发病率以比例表示。采用Kaplan Meier图估计有或无AKI患者的中位生存期。使用Cox比例风险回归分析评估AKI的危险因素。
在筛查的147例患者中，92例符合纳入标准，但2例拒绝参与研究。在研究参与者中，48例（53.3%）为男性，47例（52.2%）年龄在3岁及以下，中位烧伤总面积为17（四分位间距；13 - 23），58例（69.9%）白蛋白水平低，16例（18.6%）有吸入性烧伤。发现AKI的发病率为34.4%（95%可信区间；25.9 - 45.9），死亡率为11.76%（95%可信区间；6.37 - 20.73）。烧伤总面积HR = 3.10（95%可信区间；1.39至6.94，P = 0.003）是AKI的唯一独立危险因素。
发现重度烧伤患者中AKI的发病率和死亡率较高。烧伤总面积大于18%是AKI的独立危险因素。因此，烧伤总面积大于18%的患者应定期评估是否发生AKI，以便在发生时尽早开始治疗。
