Abstract
BackgroundAcute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction.MethodsRetrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI.ResultsThe incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p = 0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (< 33 mg/dL, [OR 5.1, 95%CI 1.4-17-7]), metabolic acidosis (OR 5.3, 95%CI 1.4-20.3), and decreased prothrombin time (OR 4.4, 95% CI 1.3-14.5). A risk score for AKI was calculated for each patient, with an OR of 1.72 (95%CI 1.45-2.04). The discrimination value of the predictive model was established by means of a ROC curve, with the area under the curve of 0.871 (p<0.001).ConclusionsThe identification of independent factors associated with AKI and a risk score for early prediction of this complication in patients with severe rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures.
Highlights
Rhabdomyolysis, a syndrome characterized by disintegration of skeletal muscle, results in release of muscle cell elements such as myoglobin and creatine kinase (CK) into the blood stream and urine
[2] The pathogenesis of rhabdomyolysis-induced Acute kidney injury (AKI) is not fully elucidated, experimental evidence suggests that intrarenal vasoconstriction, direct and ischemic tubule injury, and tubular obstruction are the main mechanisms involved
AKI is the most serious, and even life-threatening, complication of rhabdomyolysis, and is quite common, representing 7% to 10% of all cases of acute kidney injury in United States [7,8,9] the true incidence is difficult to establish owing to varying definitions and clinical scenarios, the reported AKI incidence ranges from 13% to 50%. [9,10,11] Mortality data vary widely according to the study population and setting and the number and severity of coexisting conditions
Summary
Rhabdomyolysis, a syndrome characterized by disintegration of skeletal muscle, results in release of muscle cell elements such as myoglobin and creatine kinase (CK) into the blood stream and urine. This syndrome can present as an incidental increase in serum CK levels or as a life-threatening condition with very high CK values [1] causing electrolyte disturbances, acute kidney injury (AKI), and disseminated intravascular coagulation. AKI is the most serious, and even life-threatening, complication of rhabdomyolysis, and is quite common, representing 7% to 10% of all cases of acute kidney injury in United States [7,8,9] the true incidence is difficult to establish owing to varying definitions and clinical scenarios, the reported AKI incidence ranges from 13% to 50%. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction
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