Contribution of acute kidney injury toward morbidity and mortality in burns: A contemporary analysis
Contribution of acute kidney injury toward morbidity and mortality in burns: A contemporary analysis
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DOI：
10.1053/j.ajkd.2006.12.018
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发表时间：
2007-04-01
影响因子：
13.2
通讯作者：
Parikh, Chirag R.
中科院分区：
文献类型：
--
作者：
Coca, Steven G.;Bauling, Paul;Parikh, Chirag R.
背景资料：需要透析支持的严重急性肾损伤（阿基）是严重烧伤成人中相对罕见的并发症，与死亡率大幅增加相关。目前尚不清楚是否轻度形式的阿基预后的重要性在burns.Methods：我们进行了观察性队列分析的连续患者与大烧伤承认的烧伤护理单位的三级保健中心，从1998年至2003年。我们的主要结果措施阿基分层的风险肾功能不全，肾损伤，肾功能衰竭，肾功能丧失，终末期肾病（步枪）分类和mortarity.Results：阿基发生在81 304例（26.6%）烧伤10%或更大的全身表面积。多变量分析中阿基的危险因素为吸入性损伤、导管感染和脓毒症。使用步枪分类分层的阿基患者的死亡率较高，人工通气需求较大，重症监护室和住院时间较长。与未发生阿基的患者相比，步枪阿基的“风险”和“损伤”分层患者的死亡率无显著差异，但“失败”（60%）分层患者的死亡率显著增加。在多变量分析中，年龄，更大的全身表面积，吸入性损伤，和失败的步枪分类是每个独立的predictors of death.Conclusion：总之，烧伤严重阿基患者的死亡率仍然很高，在现代重症监护医学时代不变。步枪分类增加了关于轻度阿基患者发病率的预后信息。
Background: Severe acute kidney injury (AKI) that requires dialytic support, a relatively uncommon complication in severely burned adults, is associated with a substantially increased mortality rate. It is not known whether milder forms of AKI have prognostic importance in burns.Methods: We performed an observational cohort analysis of consecutive patients with major burns admitted to the burn care unit of a tertiary-care center from 1998 to 2003. Our main outcome measures were AKI stratified by the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, and End-stage kidney disease (RIFLE) classification and mortality.Results: AKI occurred in 81 of 304 patients (26.6%) with burns on 10% or greater total-body surface area. Risk factors for AKI on multivariate analysis were inhalational injury, catheter infection, and sepsis. Patients with AKI stratified by using the RIFLE classification had greater mortality, greater requirement of artificial ventilation, and longer durations of intensive care unit and hospital stays. Mortality was not significantly different among those with the "Risk" and "Injury" strata of RIFLE AKI compared with those without AKI, but mortality increased significantly with the "Failure" (60%) strata. In multivariate analysis, age, greater total-body surface area, inhalational injury, and the RIFLE classification of Failure were each independent predictors of death.Conclusion: In conclusion, the mortality of patients with burns with severe AKI remains high and unchanged in the modern era of critical care medicine. The RIFLE classification added prognostic information regarding morbidity in patients with milder forms of AKI.