Admission Characteristics and Outcomes of ED Patients With Rhabdomyolysis

Abstract

Objective: Rhabdomyolysis is a potentially life-threatening syndrome characterized by muscle necrosis and the release of potentially toxic intracellular muscle constituents into the circulation. Acute kidney injury (AKI) is the most important complication of rhabdomyolysis and is associated with increased risk of all-cause mortality. The main objectives of this study were (1) to characterize the most common etiologies of rhabdomyolysis and (2) to determine the complications and outcomes (rhabdomyolysis-induced AKI, need for renal replacement therapy [RRT] and, 28-day mortality) in our sample. Material and Methods: This retrospective, cross sectional, and single-center study was conducted in the ED of university hospital between January 1, 2013, and December 31, 2013. We analyzed the clinical spectrum and evaluated the complications and outcomes for each patient. Results: Forty-three eligible cases were enrolled in the study. The mean age was 52.0±21.9 years (range 16 to 92), and 81.4% were men. The two most common causes of rhabdomyolysis in this sample were trauma and infections (n=16; 37.2% and n=12; 27.9%, respectively). AKI occurred in 23 patients (53.4%), 13 of whom (30.2%) required RRT. All-cause 28-day mortality rate was 44.2% (n=19). The nonsurvival group had significantly increased peak creatinine level, increased phosphate level, and prolonged aPTT ( P <.001, P =.003, and P =.001, respectively). Conclusion: A substantial proportion of patients with rhabdomyolysis developed the complications of AKI and required RRT. Early recognition and aggressive fluid replacement should be considered for ED patients with rhabdomyolysis.