Abstract
Background: Currently, no large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). Methods: We queried the National Inpatient Sample of Healthcare Cost and Utilization Project (HCUP) with patients with rhabdomyolysis from 2016 to 2018. The chi-squared test was used to compare categorical variables, and the adjusted Wald test was employed to compare quantitative variables. The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs. 53.8 ± 22.2), Medicare insurance (48.5% vs. 43.2%), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs. 5.5%). AKI was found to be independently associated with higher mortality (adjusted odds ratio [aOR] 3.33, 95% CI 2.33–4.75), longer hospital stays (adjusted difference 1.17 days, 95% CI: 1.00−1.34), and higher cost of hospital stay (adjusted difference $11,315.05, 95% CI: $9493.02–$13,137.07). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden.
Highlights
Rhabdomyolysis is a clinical condition characterized by the breakdown of skeletal muscle, which causes the release of intracellular enzymes to the bloodstream [1]
Patients with acute kidney injury (AKI) were more likely to be transferred to a short-term hospital or facility and more likely to be discharged with home health care
We analyzed the impact of AKI on clinical outcomes. (Table 2) After adjusting for hospital and individual level of confounders, AKI was found to be independently associated with a higher in-hospital mortality and complications, including hyperkalemia, electrolyte disorders, disseminated intravascular coagulation, compartment syndrome, hypovolemic shock, and mechanical ventilation. (Figure 1)
Summary
Rhabdomyolysis is a clinical condition characterized by the breakdown of skeletal muscle, which causes the release of intracellular enzymes to the bloodstream [1]. Rhabdomyolysis-related hospitalizations were reported to be approximately 26,000 a year in the U.S [3]. No large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs 53.8 ± 22.2), Medicare insurance (48.5% vs 43.2%), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs 5.5%). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden
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