BackgroundAcute kidney injury (AKI) is a common complication in burn patients admitted to the intensive care unit (ICU) associated with increased morbidity and mortality. Our primary aim was to review incidence, risk factors, and outcomes of AKI in burn patients admitted to the ICU. Secondary aims were to review the use of renal replacement therapy (RRT) and impact on health care costs.MethodsWe conducted a systematic search in PubMed, UpToDate, and NICE through 3 December 2018. All reviews in Cochrane Database of Systematic Reviews except protocols were added to the PubMed search. We searched for studies on AKI according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE); Acute Kidney Injury Network (AKIN); and/or Kidney Disease: Improving Global Outcomes (KDIGO) criteria in burn patients admitted to the ICU. We collected data on AKI incidence, risk factors, use of RRT, renal recovery, length of stay (LOS), mortality, and health care costs.ResultsWe included 33 observational studies comprising 8200 patients. Overall study quality, scored according to the Newcastle-Ottawa scale, was moderate. Random effect model meta-analysis revealed that the incidence of AKI among burn patients in the ICU was 38 (30–46) %. Patients with AKI were almost evenly distributed in the mild, moderate, and severe AKI subgroups. RRT was used in 12 (8–16) % of all patients. Risk factors for AKI were high age, chronic hypertension, diabetes mellitus, high Total Body Surface Area percent burnt, high Abbreviated Burn Severity Index score, inhalation injury, rhabdomyolysis, surgery, high Acute Physiology and Chronic Health Evaluation II score, high Sequential Organ Failure Assessment score, sepsis, and mechanical ventilation. AKI patients had 8.6 (4.0–13.2) days longer ICU LOS and higher mortality than non-AKI patients, OR 11.3 (7.3–17.4). Few studies reported renal recovery, and no study reported health care costs.ConclusionsAKI occurred in 38% of burn patients admitted to the ICU, and 12% of all patients received RRT. Presence of AKI was associated with increased LOS and mortality.Trial registrationPROSPERO (CRD42017060420)

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重症监护室烧伤患者急性肾损伤的系统评价和荟萃分析

背景急性肾损伤 (AKI) 是入住重症监护病房 (ICU) 的烧伤患者的常见并发症，与发病率和死亡率增加有关。我们的主要目的是回顾入住 ICU 的烧伤患者 AKI 的发生率、危险因素和结果。次要目的是审查肾脏替代疗法 (RRT) 的使用及其对医疗保健成本的影响。方法我们在 PubMed、UpToDate 和 NICE 中进行了系统搜索，直至 2018 年 12 月 3 日。添加了 Cochrane 系统评价数据库中除协议外的所有评价到 PubMed 搜索。我们根据风险、损伤、衰竭、肾功能丧失和终末期肾病 (RIFLE) 搜索了关于 AKI 的研究；急性肾损伤网络（AKIN）；和/或肾脏疾病：改善入住 ICU 的烧伤患者的全球预后 (KDIGO) 标准。我们收集了关于 AKI 发生率、危险因素、RRT 使用、肾脏恢复、住院时间 (LOS)、死亡率和医疗保健费用的数据。结果我们纳入了 33 项观察性研究，包括 8200 名患者。根据纽卡斯尔-渥太华量表评分，总体研究质量中等。随机效应模型荟萃分析显示，ICU 烧伤患者 AKI 的发生率为 38（30-46）%。AKI 患者几乎均匀分布在轻度、中度和重度 AKI 亚组中。RRT 用于所有患者的 12 (8–16) %。AKI 的危险因素包括高龄、慢性高血压、糖尿病、高烧伤总表面积百分比、高简化烧伤严重指数评分、吸入性损伤、横纹肌溶解、手术、高急性生理学和慢性健康评估 II 评分，高序贯器官衰竭评估评分、败血症和机械通​​气。AKI 患者比非 AKI 患者有 8.6 (4.0-13.2) 天的 ICU LOS 和更高的死亡率，OR 11.3 (7.3-17.4)。很少有研究报告肾脏恢复，也没有研究报告医疗保健费用。结论 38% 入住 ICU 的烧伤患者发生 AKI，12% 的所有患者接受 RRT。AKI 的存在与 LOS 和死亡率增加相关。试验注册 PROSPERO (CRD42017060420)