Rhabdomyolysis in Critically Ill Surgical Patients (original) (raw)
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Annals of Intensive Care, 2013
Background: Because neither the incidence and risk factors for rhabdomyolysis in the ICU nor the dynamics of its main complication, i.e., rhabdomyolysis-induced acute kidney injury (AKI) are well known, we retrospectively studied a large population of adult ICU patients (n = 1,769). Methods: CK and sMb (serum myoglobin) and uMb (urinary myoglobin) were studied as markers of rhabdomyolysis and AKI (RIFLE criteria). Hemodialysis and mortality were used as outcome variables. Results: Prolonged surgery, trauma, and vascular occlusions are associated with increasing CK values. CK correlates with sMb (p < 0.001) and peaks significantly later than sMb or uMb. The logistic regression showed a positive correlation between CK and the development of AKI, with an OR of 2.21. Univariate logistic regression suggests that elevations of sMb and uMb are associated with the development of AKI, with odds ratios of 7.87 and 1.61 respectively. The ROC curve showed that for all three markers a significant correlation with AKI, for sMb with the greatest area under the curve. The best cutoff values for prediction of AKI were CK > 773 U/l; sMb > 368 μg/l and uMb > 38 μg/l respectively.
Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis
Journal of Critical Care, 2010
Purpose: Acute renal failure (ARF) is the most important complication of rhabdomyolysis. Serial measurements of blood myoglobin might be useful for predicting rhabdomyolysis-induced ARF. Methods: Thirty patients with rhabdomyolysis were examined. The causes of rhabdomyolysis were trauma, burns, and ischemia, among others. Serial blood myoglobin levels were measured by immunochromatography, and the peak value was determined. The relationship between blood myoglobin levels and the incidence of ARF was evaluated. Results: The median peak blood myoglobin level was 3335 ng/mL. Acute renal failure occurred in 12 patients (40%). Nine patients (30%) underwent renal replacement therapy. Peak creatine kinase and peak blood myoglobin levels in the ARF group were significantly higher than those in the non-ARF group. Three patients in the ARF group were treated with renal replacement therapy before occurrence of uremia because of extremely high levels of blood myoglobin (N10 000 ng/mL). Receiver operating characteristic analysis showed that the area under the curve for blood myoglobin that predicted ARF was 0.88, and the best cutoff value for blood myoglobin was 3865 ng/mL. Conclusions: The peak value for blood myoglobin might be a good predictor of rhabdomyolysis-induced ARF. Early renal protective therapies should be considered for patients with rhabdomyolysis at high risk of ARF.
Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2017
Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM. A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with "crush protocol." Daily/twice a day, serum CPK...
Indian Journal of Surgery, 2012
Rhabdomyolysis due to trauma and burns is an important cause of acute renal failure (ARF) secondary to myoglobinuria. To prevent morbidity and mortality from ARF due to rhabdomyolysis, early detection of ARF by monitoring the biochemical parameters such as serum creatinine, serum creatine kinase (CK), and urinary myoglobin (UM) can be helpful. The aims of the study were (1) to detect ARF due to rhabdomyolysis using serum creatinine, serum CK, and UM in trauma and electrical burn patients (2) to compare utility of these parameters in early prediction of ARF in patients of rhabdomyolysis. A total of 50 patients with trauma and electrical burns were included in the study. Serum creatinine, serum CK, and UM measurements were done at the time of admission and after 48 h. Diagnosis of ARF was made in the patients by Rifle's criteria. The presence of significant elevation of creatinine, serum CK, and UM at the time of admission and after 48 h was compared in patients developing ARF by Fisher's exact test. Fifteen of the 50 patients developed ARF as per the defined criteria. Of these, 9 patients (60%) had raised level of serum creatinine above 1.4 mg% at admission and 14 patients (93.33%) had CK level >1250 U/L at admission, whereas UM was positive in 6 (40%) patients. Serum creatinine was significantly raised in all of the 15 ARF patients (100%) after 48 h of admission and serum CK was raised in 14 of the 15 ARF patients (93.33%). UM was negative in all the patients after 48 h of admission. Statistical analysis showed that rise in serum CK on admission was significantly increased in patients developing ARF as compared with serum creatinine and UM (P<0.0001). On admission, CK is a better predictor of ARF due to rhabdomyolysis than creatinine and UM. Initial creatinine is a better predictor of ARF due to rhabdomyolysis than UM. UM assay is not a good investigation for early prediction of ARF in rhabdomyolysis.
Intensive Care Medicine, 2003
Objective: To evaluate the risk factors for the development of acute renal failure (ARF) in severe rhabdomyolysis. Design: Observational historical cohort study. Setting: General intensive care unit of a university hospital. Patients: Twenty-six patients with severe rhabdomyolysis, who were admitted between July 1996 and July 2001. Measurements and results: Clinical and laboratory data were reviewed and groups were stratified according to presence or absence of acute renal failure. The underlying cause of rhabdomyolysis was ischemia by vascular obstruction (50%), crush injury by trauma (23%), sepsis (11.5%), heatstroke/hyperthermia (11.5%) and hyponatremia in a single patient. Mean creatine kinase (CK) level was 38,351±35,354 U/l on admission and rose further in all patients (mean: 59,747±67,514 U/l). Renal failure developed in 17 patients (65%). Serum CK levels correlated with onset of ARF, as these patients had significantly higher admission and peak serum CK concentrations. Patients with ARF had a higher mortality (59% vs 22%). Conclusion: In our cohort of patients with severe rhabdomyolysis the level of serum CK predicted the development of ARF. Although our results suggest that series of CK determination might be beneficial for the evaluation of the effect of therapy, the value of CK determination as a prognostic tool is limited, given the wide range of CK levels.
Acute Kidney Injury Following Rhabdomyolysis in Critically Ill Patients
The Journal of Critical Care Medicine
Introduction Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury. Aim To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients. Methods All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury. Results Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine ki...
Prophylaxis of Acute Renal Failure in Patients with Rhabdomyolysis
Renal Failure, 1997
Patients that develop rhabdomyolysis of different causes are at high risk of acute renal failure. @forts to minimize this risk include volume repletion, treatment with mannitol, and urinary ulkalinization as SOOFI as possibk? after muscle injury. This is u' retrospective analysis (from January I , 1992, to December 31,1995) of therapeutic response to prophylactic treatment in patients with rhabdomyolysis admitted to an intensive cure unit (ICU). The diagnosis of rhabdomyolysis was based on creatinine kinase (CK) level (>500 UUL) and the criteria for prophylaxis were: time elapsed between muscle injury to ICU admission < 48 h and serum creatinine < 3 mg/dL. Fifteen patients were treated with the association of saline, mannitol, and sodium bicarbonate (S+M+R group) and 9 patients received only saline (S group). Serum creatinine at admission was similar in both groups: 1.6 ? 0.6 mg/dL in the S+M+B group and 1.5 ? 0.6 mg/dL in the S group (p > 0.05). Maximum serum CK measured was 3351 2 1693 IU/L in the S + M + B group and 1747 2 2345 IU/L in the S group (p < 0.05). However the measurement of CK was earlier in S+M+B parients (1.7 vs 2.7 days after rhabdomyolysis). APACHE I1 scores were 16.9 ? 7.4 and 13.4 i 4.9 in the S + M + M B and S groups, respectively (p > 0.0.5). Despite the treatment protocol the serum levels of creatinine had similur behavior and reached normal levels in all patients in 2 or 3 days. The saline infusion during the first 60 h on the ICU was 206 mUh in
Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis
Internal Medicine Journal, 2015
Background: Rhabdomyolysis (RB) is a syndrome characterised by decomposition of skeletal muscle that could be life threatening, so the identification of biomarkers of its severity could help us in its treatment. Creatine kinase (CK) is usually taken as a reference in patients with RB in order to stratify prognosis, however that is not probably the most effective parameter. Aims: The present study was designed to analyse the specific features and mortality of patients with RB and the relation between creatinine, CK and mortality. Methods: Retrospective cohort analysis among patients admitted to San Pedro Hospital in Logroño (Spain) with RB (CK levels higher than 2000 U/L) diagnosed since 1 January 2009 until 31 December 2; 013 522 patients with RB patients diagnosed of RB were collected. The aetiology and the analytical feature (creatinine, CK, calcium, phosphorus, pH and bicarbonate), as well as 30-year mortality, were investigated. Results: Among the 522 patients, there were 138 deaths. Four patients required renal replacement therapy. The most common cause of RB was trauma (29%). Infectious aetiology had the highest mortality (41.2%). The median CK was 3451 u/L (interquartile range 3348), and the mean creatinine at admission was 132.6 umol/L (±110.5). Initial CK levels do not have predictive ability on mortality or renal dysfunction in contrast to initial creatinine values. Each state of acute kidney injury (AKI) increased mortality compared with those who have not presented this renal dysfunction (P < 0.0001). Age, calcium, phosphorus, bicarbonate and pH are associated with AKI. Conclusion: Despite being a diagnostic marker for RB, initial CK levels do not predict mortality. However, creatinine initial levels are related to progression to acute renal injury and mortality at 30 days.
South African Medical Journal, 2021
Myorenal syndrome following significant soft-tissue injury remains a common presentation in South Africa (SA). [1,2] The pathophysiology of massive soft-tissue disruption has been well described and involves myoglobin deposition in the proximal renal tubules. [3-5] The mainstay of therapy involves judicious rehydration to ensure adequate diuresis. [6,7] If not managed, myorenal syndrome can progress to acute kidney injury (AKI), which may require renal replacement therapy (RRT). If RRT is required, there is significant associated morbidity and mortality. [8] Identifying patients at risk for the development of AKI requiring RRT is important, as it can prompt the appropriate degree of clinical concern. [1,2] In SA there are regional differences in the diagnostic modalities used to grade these injuries and in the management protocols. In Western Cape Province there is a tendency to use creatinine kinase (CK) levels, whereas in KwaZulu-Natal (KZN) Province the use of venous bicarbonate (HCO 3) has been widespread since it was first popularised by Muckart et al. [2] three decades ago. Objectives To compare the spectrum and outcome of myorenal syndrome between two busy centres, namely Khayelitsha District Hospital (KDH) in Cape Town, Western Cape, and Ngwelazana Hospital (NH) in Empangeni, KZN. It is hoped that this may help provide some clarity in the ongoing controversy as to which method of grading is most appropriate and effective. Methods The study involved a retrospective chart review of all patients presenting to KDH and NH with myorenal syndrome from January to December 2017. Demographic information as well as injury This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Venous bicarbonate and creatine kinase as diagnostic and prognostic tools in the setting of acute traumatic rhabdomyolysis