Yanýk yoðun bakým hastalarýnda akut böbrek hasarý: Retrospektif araþtýrma

AMAÇ: Akut böbrek hasarý, yanýk travmalý hastalarda yüksek mortalite ve morbidite ile iliþkili yaygýn komplikasyonlardan biridir. Bu çalýþmada, yanýk hastalarýnda KDIGO kriterlerine göre akut böbrek hasarý geliþme sýklýðý, etkileyen faktörleri ve mortalite oranlarýnýn belirlenmesi amaçlanmýþtýr. GEREÇ VE YÖNTEM: Çalýþmaya en az 48 saat hastanede yatan ve 18 yaþýndan büyük hastalar dahil edilirken, böbrek transplantasyonu olan, kronik böbrek yetersizliði olan, hemodiyaliz uygulanan, 18 yaþýndan küçük, baþvuru sýrasýnda glomerüler filtrasyon hýzý <15 olan hastalar ve toksik epidermal nekroliz tanýlý hastalar çalýþma dýþý býrakýlmýþtýr. Akut böbrek hasarý, KDIGO sýnýflamasýna göre saptandý. Hastalarýn yaþ, cinsiyet, yanýk etiyolojileri, ya-nýk yüzdeleri, inhalasyon hasarýnýn varlýðý, ilk 72 saatte Parkland formülü ile verilen total sývý miktarý, mekanik ventilatör desteði, inotrop/vazopresör ihtiyacý, yoðun bakým kalýþ süresi, mortalite, Abbreviated Burn Severity Index (ABSI), Acute Physiology and Chronic Health Evaluation II (APACHE II) ve Sequential Organ Failure Assessment (SOFA) deðerleri kaydedildi.
BULGULAR: Çalýþmamýza akut böbrek hasarý geliþen (+) grupta 26 (%54.2), akut böbrek hasarý geliþmeyen (-) grupta 22 (%45.8) olmak üzere toplam 48 hasta dahil edildi. Akut böbrek hasarý (+) grubunda ortalama toplam yanýk yüzey alaný %47.30, akut böbrek hasarý (-) grubunda ise%19.88 idi. Abbreviated Burn Severity Index (ABSI), Acute Physiology and Chronic Health Evaluation II (APACHE II) ve Sequential Organ Failure Assessment (SOFA), mekanik ventilasyon ve inotrop/vazopresör desteði ve sepsis varlýðýnýn akut böbrek hasarý (+) olan grupta anlamlý olarak daha yüksekti. Akut böbrek hasarý (-) grubunda mortalite saptanmazken, akut böbrek hasarý (+) grubunun mortalite oraný %34.6 olduðu görüldü ve anlamlý derecede yüksekti.
TARTIÞMA: Akut böbrek hasarýnýn, yanýklý hastalarda yüksek morbidite ve mortalite ile iliþkili olduðu görüldü. Kidney Disease Improving Global Outcomes sýnýflandýrmasýnýn günlük takipte kullanýlmasý erken tanýda faydalýdýr.

Acute kidney injury in burns in the intensive care unit: A retrospective research

BACKGROUND: Acute kidney injury (AKI) is one of the common complications, associated with high mortality and morbidity in patients with burn injuries. This study aimed to determine the frequency of AKI development, its affective factors, and mortality rates according to kidney disease improving global outcomes (KDIGO) criteria in the burn patients.
METHODS: The study included patients who are hospitalized for at least 48 h and aged >18 years, whereas patients with a renal transplant, chronic renal failure, undergoing hemodialysis, <18 years of age, with a glomerular filtration rate of <15 on admission, and toxic epidermal necrolysis was excluded from the study. KDIGO criteria were used to evaluate the occurrence of AKI. Burn mech-anism, total body surface area, inhalation injury respiratory tract burn, fluid replacement at 72 h with Parkland Formula, mechanical ventilator support, inotrope/vasopressor support, intensive care unit, lenght of stay, mortality, abbreviated burn severity index (ABSI), acute physiology, and chronic health evaluation II (APACHE II) ve Sequential organ failure assessment (SOFA) were recorded.
RESULTS: A total of 48 patients were included in our study, of which 26 (54.2%) developed AKI (+), whereas 22 (45.8%) did not (−). The mean total burn surface area was 47.30% in the AKI (+) group and 19.88% in the AKI (−) group. Mean scores of ABSI, II (APACHE II), and SOFA, the mechanical ventilation and inotrope/vasopressor support and the presence of sepsis were significantly higher in the AKI (+). No mortality was determined in the AKI (−) group, whereas 34.6% in the AKI (+) group which was significantly high.
CONCLUSION: AKI was related to high morbidity and mortality in patients with burns. Using KDIGOs, classification in daily fol-low-up is useful in early diagnosis.