Construction and evaluation of a risk prediction model for acute kidney injury in severe burn patients

XIANG He-dong; CHEN Wen-zhao; ZHANG Hong-zhuang; WEI Li-tao; ZHAN Pei; YANG Wei; LI Chang-quan; QIAO Meng; CHEN Chao-wei; TIAN Zhi-qiang

doi:10.11659/jjssx.10E024066

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Construction and evaluation of a risk prediction model for acute kidney injury in severe burn patients

Clinical Research | 更新时间：2025-10-24

- Construction and evaluation of a risk prediction model for acute kidney injury in severe burn patients
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 34, Issue 10, Pages: 886-891(2025)
- 作者机构：
  
  1.中国人民解放军联勤保障部队第九二三医院急诊医学科，广西南宁530021
  2.中国人民武装警察部队特色医学中心烧伤冻伤及组织功能重建研究所，天津 300162
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.10E024066
  CLC： R473.6
- Received：09 October 2024，
  
  Published：25 October 2025
- 稿件说明：
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向和东,陈文昭,张洪壮等.严重烧伤患者发生急性肾损伤的风险预测模型构建与评价[J].局解手术学杂志,2025,34(10):886-891.

XIANG He-dong,CHEN Wen-zhao,ZHANG Hong-zhuang,et al.Construction and evaluation of a risk prediction model for acute kidney injury in severe burn patients[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(10):886-891.
向和东,陈文昭,张洪壮等.严重烧伤患者发生急性肾损伤的风险预测模型构建与评价[J].局解手术学杂志,2025,34(10):886-891. DOI： 10.11659/jjssx.10E024066.

XIANG He-dong,CHEN Wen-zhao,ZHANG Hong-zhuang,et al.Construction and evaluation of a risk prediction model for acute kidney injury in severe burn patients[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2025,34(10):886-891. DOI： 10.11659/jjssx.10E024066.

摘要

目的

探究严重烧伤患者发生急性肾损伤的影响因素，并构建可视化的风险列线图模型。

方法

收集中国人民武装警察部队特色医学中心烧伤冻伤及组织功能重建研究所2018年1月至2022年1月收治的严重烧伤患者390例作为内部训练数据集，另收集2022年2—12月收治的严重烧伤患者50例作为外部验证数据集。根据是否发生急性肾损伤将内部训练数据集的390例患者分为急性肾损伤组和非急性肾损伤组，比较2组患者基线资料。采用单因素和多因素

Logistic

回归分析内部训练数据集中严重烧伤患者发生急性肾损伤的危险因素，并绘制列线图模型，随后对该模型进行内外部验证；采用

Kaplan

Meier

分析和

Log

rank

检验比较急性肾损伤组和非急性肾损伤组患者烧伤后90 d生存率。

结果

烧伤面积（

=1.18，95%

：1.06~2.36，

=0.004)、序贯性器官功能衰竭（SOFA）评分（

=1.81，95%

：1.21~5.92，

0.001）、吸入性损伤（

=3.21，95%

：1.23~6.35，

0.001)、中性粒细胞-淋巴细胞比值（NLR）（

=1.22，95%

：1.05~3.65，

0.001)、白蛋白（ALB）（

=0.78，95%

：0.57~0.92，

=0.011)是严重烧伤患者发生急性肾损伤的独立危险因素；通过以上因素建立列线图模型，内部训练数据集受试者工作特征曲线下面积（

AUC

）为0.833（95%

：0.752~0.935），敏感度为81.2%，特异度为83.2%；外部验证数据集

AUC

为0.842（95%

：0.762~0.912），敏感度为87.2%，特异度为78.7%。急性肾损伤组患者烧伤后90 d生存率显著低于非急性肾损伤组（

0.001）。

结论

烧伤面积较大、SOFA评分较高、合并吸入性损伤、NLR升高和ALB水平降低是严重烧伤患者发生急性肾损伤的危险因素，且与患者烧伤后90 d生存率相关，基于危险因素构建的列线图模型可为临床个体化预防和治疗严重烧伤患者的急性肾损伤提供一定参考。

Abstract

Objective

To explore the influencing factors of acute kidney injury in severe burn patients，and to construct a visual risk nomogram model.

Methods

A total of 390 patients with severe burn admitted to the Institute of Burn Frostbite and Tissue Function Reconstruction of Chinese People's Armed Police Force Specialty Medical Center from January 2018 to January 2022 were collected as an internal training data set，and 50 patients with severe burn admitted from February to December 2022 were collected as an external validation data set.The 390 patients of the internal training data set were divided into the acute kidney injury group and the non-acute kidney injury group according to the occurrence of acute kidney injury，and the baseline data of patients in the two groups were compared.Univariate and multivariate

Logistic

regression were used to analyze the risk factors of acute kidney injury in severe burn patients of the internal training data set，and a nomogram model was drawn.Subsequently， the model was verified both internally and externally.

Kaplan

Meier

analysis and

Log

rank

test were used to compare the 90-day survival rate of patients between the acute kidney injury group and the non-acute kidney injury group.

Results

The burn area （

=1.18，95%

：1.06 to 2.36，

=0.004），sequential organ failure assessment （SOFA） score （

=1.81，95%

：1.21 to 5.92，

0.001），inhalation injury （

=3.21，95%

：1.23 to 6.35，

0.001），neutrophil to lymphocyte ratio （NLR）（

=1.22，95%

：1.05 to 3.65，

0.0

01） and albumin （ALB）（

=0.78，95%

：0.57 to 0.92，

=0.011） were the independent risk factors for the development of acute kidney injury in severe burn patients.The nomogram model was established by the above factors.The

area under the receiver operating characteristic curve

（

AUC

） of the internal training data set was 0.833 （95%

：0.752 to 0.935），the sensitivity was 81.2%，and the specificity was 83.2%.The

AUC

of the external validation data set was 0.842 （95%

：0.762 to 0.912），the sensitivity 87.2%，and the specificity was 78.7%.The 90-day survival rate of patients in the acute kidney injury group after burns was significantly lower than that in the non-acute kidney injury group （

0.001）.

Conclusion

Larger burn area， higher SOFA score， combined inhalation injury， increased NLR， and decreased ALB level are the risk factors for the occurrence of acute kidney injury in severe burn patients， which are related to the 90-day survival rate of patients after burns.The nomogram model based on the risk factors can provide certain reference for clinical individualized prevention and treatment of acute kidney injury in severe burn patients.

关键词

Keywords

references

Folkestad T ， Brurberg KG ， Nordhuus KM ， et al . Acute kidney injury in burn patients admitted to the intensive care unit：a systematic review and meta-analysis ［J］. Critical Care （London，England）， 2020 ， 24 （ 1 ）： 2 . doi： 10.1186/s13054-019-2710-4 http://dx.doi.org/10.1186/s13054-019-2710-4 .

Bagshaw SM ， Wald R ， Adhikari NKJ ， et al . Timing of initiation of renal-replacement therapy in acute kidney injury ［J］. N Engl J Med ， 2020 ， 383 （ 3 ）： 240 - 251 . doi： 10.1056/NEJMoa2000741 http://dx.doi.org/10.1056/NEJMoa2000741 .

Niculae A ， Peride I ， Tiglis M ， et al . Burn-induced acute kidney injury-two-lane road：from molecular to clinical aspects ［J］. Int J Mol Sci ， 2022 ， 23 （ 15 ）： 8712 . doi： 10.3390/ijms23158712 http://dx.doi.org/10.3390/ijms23158712 .

Tejiram S ， Romanowski KS ， Palmieri TL . Initial management of severe burn injury ［J］. Curr Opin Crit Care ， 2019 ， 25 （ 6 ）： 647 - 652 . doi： 10.1097/mcc.0000000000000662 http://dx.doi.org/10.1097/mcc.0000000000000662 .

Lavrentieva A ， Depetris N ， Moiemen N ， et al . Renal replacement therapy for acute kidney injury in burn patients，an international survey and a qualitative review of current controversies ［J］. Burns ， 2022 ， 48 （ 5 ）： 1079 - 1091 . doi： 10.1016/j.burns.2021.08.013 http://dx.doi.org/10.1016/j.burns.2021.08.013 .

Karakaya E ， Akdur A ， Aydoğan C ， et al . A model for acute kidney injury in severe burn patients ［J］. Burns ， 2022 ， 48 （ 1 ）： 69 - 77 . doi： 10.1016/j.burns.2021.04.004 http://dx.doi.org/10.1016/j.burns.2021.04.004 .

Xue FS ， Liu YY ， Yang GZ . Assessing clinical significance of acute kidney injury in burn patients ［J］. Ann Surg ， 2018 ， 268 （ 6 ）： e55 . doi： 10.1097/sla.0000000000002546 http://dx.doi.org/10.1097/sla.0000000000002546 .

Martins J ， Nin N ， Muriel A ， et al . Early acute kidney injury is associated with in-hospital adverse outcomes in critically ill burn patients：an observational study ［J］. Nephrol Dial Transplant ， 2023 ， 38 （ 9 ）： 2002 - 2008 . doi： 10.1093/ndt/gfac339 http://dx.doi.org/10.1093/ndt/gfac339 .

Rakkolainen I ， Lindbohm JV ， Vuola J . Factrs associated with acute kidney injury in the Helsinki Burn Centre in 2006-2015 ［J］. Scand J Trauma Resusc Emerg Med ， 2018 ， 26 （ 1 ）： 105 . doi： 10.1186/s13049-018-0573-3 http://dx.doi.org/10.1186/s13049-018-0573-3 .

Kuvvet Yoldaş T ， Atalay A ， Balcı C ， et al . Acute kidney injury in burns in the intensive care unit：a retrospective research ［J］. Ulus Travma Acil Cerrahi Derg ， 2023 ， 29 （ 3 ）： 321 - 326 . doi： 10.14744/tjtes.2022.95048 http://dx.doi.org/10.14744/tjtes.2022.95048 .

Dépret F ， Amzallag J ， Pollina A ， et al . Circulating dipeptidyl peptidase-3 at admission is associated with circulatory failure，acute kidney injury and death in severely ill burn patients ［J］. Crit Care ， 2020 ， 24 （ 1 ）： 168 . doi： 10.1186/s13054-020-02888-5 http://dx.doi.org/10.1186/s13054-020-02888-5 .

杜文茜，陈文娣，吴婷婷，等 . 脱细胞异体真皮联合自体刃厚皮片移植修复小儿头面颈躯深度烧伤创面的效果研究［J］. 局解手术学杂志， 2023 ， 32 （ 11 ）： 990 - 993 . doi： 10.11659/jjssx.11E022062 http://dx.doi.org/10.11659/jjssx.11E022062 .

卢志，王立华，贾岚，等 . 中性粒细胞与淋巴细胞比值对急性肾损伤预测作用的Meta分析［J］. 中华危重病急救医学， 2021 ， 33 （ 3 ）： 311 - 317 . doi： 10.3760/cma.j.cn121430-20201215-00755 http://dx.doi.org/10.3760/cma.j.cn121430-20201215-00755 .

Wiedermann CJ . Hypoalbuminemia and the risk of acute kidney injury in sepsis ［J］. Crit Care Med ， 2019 ， 47 （ 4 ）： e377 - e378 . doi： 10.1097/ccm.0000000000003592 http://dx.doi.org/10.1097/ccm.0000000000003592 .

Hansrivijit P ， Yarlagadda K ， Cheungpasitporn W ， et al . Hypoalbuminemia is associated with increased risk of acute kidney injury in hospitalized patients：a meta-analysis ［J］. J Crit Care ， 2021 ， 61 ： 96 - 102 . doi： 10.1016/j.jcrc.2020.10.013 http://dx.doi.org/10.1016/j.jcrc.2020.10.013 .

Wang Q ， Tang Y ， Zhou J ， et al . A prospective study of acute kidney injury in the intensive care unit：development and validation of a risk prediction model ［J］. J Transl Med ， 2019 ， 17 （ 1 ）： 359 . doi： 10.1186/s12967-019-2118-6 http://dx.doi.org/10.1186/s12967-019-2118-6 .

Chen B ， Zhao J ， Zhang Z ， et al . Clinical characteristics and risk factors for severe burns complicated by early acute kidney injury ［J］. Burns ， 2020 ， 46 （ 5 ）： 1100 - 1106 . doi： 10.1016/j.burns.2019. 11.018 http://dx.doi.org/10.1016/j.burns.2019.11.018 .

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