Rhabdomyolysis in Community Acquired Bacterial Sepsis – A Retrospective Cohort Study

Anita A Kumar,Porchelvan Swaminathan,Georgi Abraham,Ghanshyam Palamaner Subash Shantha,Emmanuel Bhaskar,Patricia T Bozza

doi:10.1371/journal.pone.0007182

Anita A Kumar, Porchelvan Swaminathan + Show 4 more

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https://doi.org/10.1371/journal.pone.0007182

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Abstract

Background and ObjectivesRhabdomyolysis is often associated with sepsis and gram positive bacterial pathogens are reported to be the most frequent cause of sepsis induced rhabdomyolysis. We report the pattern of infecting bacterial pathogens and associated causal factors in a South-Indian cohort.Design, Setting, Participants & MeasurementsRetrospective cohort study of adult patients with community acquired bacterial sepsis complicated by rhabdomyolysis from March 2003 - August 2008. Rhabdomyolysis was defined as serum creatine kinase >2000 IU/L. The study population was divided into group-I (sepsis with gram positive pathogens), group–II (sepsis with gram negative pathogens) and group-III (culture negative sepsis).Results103 patients (group I -15, group II- 34 and group III- 54) formed the study cohort. Mean age was 55 years and two-third had diabetes. Mean creatine kinase was 7114 IU/L and mean serum creatinine on admission was 2.4 mg/dl. Causative pathogen of sepsis was identified in 47.5%. Gram negative pathogens were more frequently (33%) associated with rhabdomyolysis than gram positive pathogens (14.5%). Lung was the commonest foci of sepsis (38.8%). 78.6% of the study population had one or more additional causal factor for rhabdomyolysis like statin intake, chronic alcoholism, hypokalemia, hypernatremia and hypophosphatemia. Mortality was 59%.ConclusionsGram negative bacterial pathogens were more frequently associated with rhabdomyolysis than gram positive pathogens. Rhabdomyolysis in patients with sepsis is multifactorial and is associated with high mortality.

Highlights

Rhabdomyolysis can be defined as disruption of skeletal muscle leading to leakage of intracellular muscle constituents especially myoglobin into the extracellular fluid [1]
Lung was the commonest foci of sepsis (38.8%). 78.6% of the study population had one or more additional causal factor for rhabdomyolysis like statin intake, chronic alcoholism, hypokalemia, hypernatremia and hypophosphatemia
Gram negative bacterial pathogens were more frequently associated with rhabdomyolysis than gram positive pathogens

Summary

Introduction

Rhabdomyolysis can be defined as disruption of skeletal muscle leading to leakage of intracellular muscle constituents especially myoglobin into the extracellular fluid [1]. Acute renal failure complicates 10 to 67% cases of rhabdomyolysis and is an important cause of mortality [5,6,7]. Published reports have used a value of 1000 to 2500 IU/L (5 to 10 times the upper limit of normal) as a clinically significant elevation which may predispose to acute renal failure [8,9]. Values of CK as low as 519 IU/L have been associated with marked elevation in serum myoglobin and biopsy proven renal failure due to rhabdomyolysis [10]. Rhabdomyolysis is often associated with sepsis and gram positive bacterial pathogens are reported to be the most frequent cause of sepsis induced rhabdomyolysis. We report the pattern of infecting bacterial pathogens and associated causal factors in a South-Indian cohort

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