Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study.
Acute kidney injury is common, parallels organ dysfunction or failure, and carries appreciable mortality in patients with major burns: a prospective exploratory cohort study.
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DOI：
10.1186/cc7032
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Sjoberg F
中科院分区：
文献类型：
--
作者：
Steinvall I;Bak Z;Sjoberg F
本研究的目的是确定严重烧伤后急性肾损伤的发生率、时间进程和结果，并评估可能的诱发因素（年龄、性别、损伤深度和程度）的影响以及与其他器官功能障碍和脓毒症的关系。我们对入住国家烧伤中心的 TBSA%（全身表面积烧伤百分比）为 20% 或以上的患者进行了一项探索性队列研究。急性肾损伤根据RIFLE国际共识分类（风险、损伤、衰竭、肾功能丧失和终末期肾病）进行分类。前瞻性收集的临床和实验室数据用于评估器官功能障碍、全身炎症反应和脓毒症。严重烧伤中急性肾损伤的发生率为每年每10万人中有0.11人。在 127 名患者中，31 名 (24%) 出现急性肾损伤（12% 为风险，8% 为损伤，5% 为失败）。平均年龄为 40.6 岁（95% 置信区间 [CI] 36.7 至 44.5），TBSA% 为 38.6%（95% CI 35.5% 至 41.6%），25% 为女性。死亡率为 14%，并且随着 RIFLE 级别的增加而增加（正常 7%，风险 13%，受伤 40%，失败 83%）。 55% 的患者在 7 天内出现肾功能障碍，所有幸存者均恢复正常。发生急性肾损伤的患者的年龄、TBSA% 和全层烧伤程度较高。所有急性肾损伤患者均存在肺功能障碍和全身炎症反应综合征，并在急性肾损伤之前发生。脓毒症是 48% 的急性肾损伤的可能加重因素。大面积深度烧伤（25% 或更多全层烧伤）会增加早期发生急性肾损伤的风险（风险比 2.25）。急性肾损伤很常见，烧伤后很快就会发生，并且与其他器官功能障碍相似。尽管所有幸存者的急性肾损伤均已恢复，但在急性肾损伤较高的人群中，以及心血管功能障碍，它与死亡率相关。
The purpose of this study was to determine the incidence, time course, and outcome of acute kidney injury after major burns and to evaluate the impact of possible predisposing factors (age, gender, and depth and extent of injury) and the relation to other dysfunctioning organs and sepsis. We performed an explorative cohort study on patients with a TBSA% (percentage burned of total body surface area) of 20% or more who were admitted to a national burn centre. Acute kidney injury was classified according to the international consensus classification of RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease). Prospectively collected clinical and laboratory data were used for assessing organ dysfunction, systemic inflammatory response, and sepsis. The incidence of acute kidney injury among major burns was 0.11 per 100,000 people per year. Of 127 patients, 31 (24%) developed acute kidney injury (12% Risk, 8% Injury, and 5% Failure). Mean age was 40.6 years (95% confidence interval [CI] 36.7 to 44.5), TBSA% was 38.6% (95% CI 35.5% to 41.6%), and 25% were women. Mortality was 14% and increased with increasing RIFLE class (7% normal, 13% Risk, 40% Injury, and 83% Failure). Renal dysfunction occurred within 7 days in 55% of the patients and recovered among all survivors. Age, TBSA%, and extent of full thickness burns were higher among the patients who developed acute kidney injury. Pulmonary dysfunction and systemic inflammatory response syndrome were present in all of the patients with acute kidney injury and developed before the acute kidney injury. Sepsis was a possible aggravating factor in acute kidney injury in 48%. Extensive deep burns (25% or more full thickness burn) increased the risk for developing acute kidney injury early (risk ratio 2.25). Acute kidney injury is common, develops soon after the burn, and parallels other dysfunctioning organs. Although acute kidney injury recovered in all survivors, in higher acute kidney injury groups, together with cardiovascular dysfunction, it correlated with mortality.
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影响因子：
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