澳大利亚和新西兰成年烧伤患者的早期急性肾损伤。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2024-10-18 DOI:10.1016/j.jss.2024.09.053

Samuel Sharp MD , Lincoln Tracy PhD , Yvonne Singer RN, MPH , Marc Schnekenburger MBBS , Aidan Burrell MBBS , Andrew Paton MBChB , Stephen Salerno MBBS , Dane Holden MBBS

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引用次数: 0

摘要

简介：烧伤后的急性肾损伤（AKI）与死亡率和发病率的增加有关。一些患者需要进行肾脏替代治疗。早期 AKI 是指烧伤后入住烧伤中心后 72 小时内发生的 AKI，目前只有有限的大规模数据可以充分验证影响早期 AKI 发生率和严重程度的风险因素。本研究旨在比较澳大利亚和新西兰烧伤中心收治的烧伤面积≥10%、发生早期AKI的成年患者与未发生AKI的患者的情况，并量化早期AKI与院内预后之间的关系：从澳大利亚和新西兰烧伤登记处提取了2016年7月至2021年6月期间澳大利亚或新西兰烧伤中心收治的烧伤面积≥10% TBSA的成人（≥18岁）的数据。所有在最初 72 小时内进行过两次有效血清肌酐血液检测的患者均被纳入研究范围。研究了患者概况和院内预后的差异。采用单变量和多变量逻辑及线性回归模型来量化早期 AKI 与相关结果之间的关联：共有 1297 名患者符合本研究的纳入标准。83名患者（6.4%）出现了早期 AKI。与没有发生 AKI 的患者相比，发生 AKI 的患者年龄更大（P = 0.006），烧伤的中位 TBSA 百分比更高（P 结论：这是一项首次对早期 AKI 和相关结果进行研究的大规模研究：这是首次对TBSA≥10%的成人烧伤患者的早期AKI进行大规模研究。AKI 的发生率低于之前的报道，AKI 与较高的院内死亡率和机械通气需求增加有关。这些研究结果支持这样一种观点，即在烧伤后的初期阶段发生 AKI 可能会产生潜在的后果，因此应给予适当的护理以防止其发生。

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Early Acute Kidney Injury in Adult Patients With Burns in Australia & New Zealand

Introduction

Acute kidney injury (AKI) following burns is associated with increased mortality and morbidity. Some patients require renal replacement therapy. There is limited large-scale data to sufficiently validate risk factors influencing the incidence and severity of early AKI, defined as AKI within the first 72 h since admission to a burn center following burn injury. The aims of this study were to compare the profile of adult patients admitted to Australian and New Zealand burn centers, with burns ≥10% total body surface area (TBSA) who developed early AKI with patients who did not develop AKI and to quantify the association between early AKI and in-hospital outcomes.

Methods

Data were extracted from the Burns Registry of Australia and New Zealand for adults (≥18 y), with burns ≥10% TBSA admitted to Australian or New Zealand burn centers between July 2016 and June 2021. All patients with two valid serum creatinine blood tests within the first 72 h were included. Differences in patient profiles and in-hospital outcomes were investigated. Univariable and multivariable logistic and linear regression models were used to quantify associations between early AKI and outcomes of interest.

Results

There were 1297 patients who met the inclusion criteria for this study. Eighty-three patients (6.4%) developed early AKI. Compared to patients without AKI, patients with an AKI were older (P = 0.006), had a greater median %TBSA burned (P < 0.001), and had an inhalation injury (P < 0.001). In adjusted models, the development of early AKI was significantly associated with in-hospital mortality (adjusted odds ratio (aOR) [95% CI] 2.73 [1.33, 5.62], P < 0.001) and the need for mechanical ventilation (aOR [95% CI] 3.44 [1.77, 6.68], P = 0.001), but there was no significant increase in the hospital length of stay or intensive care unit length of stay.

Conclusions

This is the first large-scale study looking at early AKI in adult burns ≥10% TBSA. The incidence of AKI was lower than previously reported and AKI was associated with higher in-hospital mortality and increased need for mechanical ventilation. These findings support the notion that development of AKI in the immediate phase post burns injury can potentially have consequences and the appropriate care should be given to prevent its development.

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.