关键词: 重度烧伤, 并发症, 急性肾损伤, 预后, 治疗

Abstract: Objective:To investigate the influencing factors for the progression of acute kidney injury (AKI) in patients with severe burns complicated by AKI and to establish a predictive model. Methods:A retrospective analysis was conducted on the clinical data of 89 patients with severe burns complicated by AKI admitted to Dongnan Hospital of Xiamen University from 2020 to 2024. Patients were divided into the progression group (n=36) and non-progression group (n=53) based on whether AKI progressed. General patient information, burn characteristics, and clinical indicators were collected. Logistic multivariate analysis was used to identify factors influencing AKI progression. A risk prediction model was established based on multivariate results, and receiver operating characteristic (ROC) curves were plotted to calculate the area under the curve (AUC) for evaluating predictive efficacy. Results:No statistically significant difference was observed in general data such as age, gender, burn cause, hypertension, or diabetes between the two groups (P>0.05). The time from injury to admission was longer in the progression group than in the non-progression group (P<0.05). The progression group exhibited higher total burn area, full-thickness burn area, time to initiation of continuous renal replacement therapy (CRRT), serum creatinine, blood urea nitrogen, and cystatin C (Cys C) levels, as well as higher incidences of inhalation injury and shock (all P<0.05). Logistic multivariate analysis identified total burn area (OR=3.735, 95%CI 1.756-6.432), shock (OR=3.110, 95%CI 1.305-7.329), CRRT initiation time (OR=0.147, 95%CI 0.031-0.703), and serum creatinine (OR=5.085, 95%CI 1.953-7.442) as independent influencing factors. The predictive model was constructed as: Logit (P)=-68.536+0.855×Time from injury to admission (h)+1.317×Total burn surface area (TBSA, %)+1.304×Inhalation injury (0=No, 1=Yes)+1.134×Shock (0=No, 1=Yes)+0.724×Full-thickness burn area (%)-1.917×Time to initiation of CRRT(h)+1.626×Serum creatinine(μmol/L)+1.121×Blood urea nitrogen(BUN, mmol/L)+1.266×CysC (mg/L). The ROC curve analysis showed an AUC of 0.973, with a sensitivity of 0.962 and specificity of 0.899 for predicting AKI progression. Draw the calibration curve and perform the Hosmer-Lemeshow test, with χ²=7.648, P=0.349, and 95%CI 0.012-0.494. Conclusion:Total burn area, shock, CRRT initiation time, and serum creatinine are significant influencing factors for AKI progression in patients with severe burns complicated by AKI, demonstrating good predictive value for AKI progression.

Key words: severe burn, complications, acute kidney injury, prognosis, treatment