Rhabdomyolysis Patients Research Articles

Acute renal injury due to rhabdomyolysis: A tertiary hospital experiencee

Aim: Rhabdomyolysis (RML) is a clinical and biochemical syndrome caused by acute necrosis of striated muscle fibers and the subsequent transportation of potentially toxic cellular contents into the systemic circulation. In this study, we present data from rhabdomyolysis patients that developed acute renal failure who were hospitalized and treated in our clinic in 2019. Materials and Methods: We reviewed all cases of RML treated in the tertiary hospital within a 12-month period, which was defined as serum creatinine kinase (CK) levels > five times the upper normal limit. The inclusion criteria were as follow: (a) being aged ≥ 18 years, (b) being treated for RML within the designated time period, (c) AKI development. The exclusion criteria are as follows: (a) being aged 5 time upper normal limit (UNL), 14 conformed to the inclusion criteria and were selected as subjects Results: A total of 14 patients were included in the study, 12 of which were male. The mean age of the patients was 48.1 (18–80). The etiologies were as follows: hypothyroidism, 3; prolonged exposure to sun, 2; electrolyte imbalance due to severe diarrhea, 1; viral upper respiratory tract infection (URTI), 3; intramuscular injection, 1; heavy exercise or falls.Conclusion: Rhabdomyolysis is an interdisciplinary clinical condition that can lead to life-threatening outcomes including AKI. Rapid diagnosis and treatment can be life-saving. AKI is a significant potential complication of RML and renal function should be evaluated irrespective of CK levels or the presence of myoglobinuria.

Rhabdomyolysis in pediatric trauma patients in an intensive care unit

Rhabdomyolysis is a potentially life-threatening condition that can have significant consequences, such as acute kidney injury. There are few studies assessing rhabdomyolysis in children following trauma. We intent to characterize rhabdomyolysis and its outcomes in trauma patients admitted to a pediatric intensive care unit. A retrospective study was conducted in an urban trauma centre. In four years, ninety-five pediatric trauma patients were admitted to intensive care. In 35 (36.8%) cases, creatine kinase levels were not assessed. Of the remaining 60, rhabdomyolysis was present in 29 (48.3%). Symptoms were present in two cases. Six patients (20.7%) developed subsequent acute kidney injury, and one patient required venous hemodiafiltration. Three patients died from other complications, and none developed chronic kidney disease. Rhabdomyolysis is a frequent complication of trauma and should be assessed systematically in pediatric trauma patients requiring intensive care. Acute kidney injury is an important complication of rhabdomyolysis, although its incidence in children may be smaller. Higher creatinine levels on admission and Pediatric Risk of Mortality scores were predictive of renal impairment in rhabdomyolysis patients.

Clinical Evaluation of Non-Traumatic Rhabdomyolysis Patients Followed in the Internal Diseases Clinic

Clinical Evaluation of Non-Traumatic Rhabdomyolysis Patients Followed in the Internal Diseases Clinic

Risk factors for severe acute kidney injury among patients with rhabdomyolysis

BackgroundAcute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of severe AKI defined as stage II or III of KDIGO classification and in-hospital mortality of AKI following RM.MethodsWe performed a retrospective study of patients with creatine kinase levels > 1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted.ResultsFor the 329 patients included in our study, the incidence of AKI was 61.4% and the proportion of stage I, stage II, stage III were 18.8, 14.9 and 66.3%, respectively. The overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P < 0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to severe AKI. The risk factors for the occurrence of stage II-III AKI among RM patients included hypertension (OR = 2.702), high levels of white blood cell count (OR = 1.054), increased triglycerides (OR = 1.260), low level of high-density lipoprotein cholesterol (OR = 0.318), elevated serum phosphorus (OR = 5.727), 5000<CK ≤ 10,000 U/L (OR = 2.617) and CK>10,000 U/L (OR = 8.093). Age ≥ 60 years (OR = 2.946), sepsis (OR = 3.206) and elevated prothrombin time (OR = 1.079) were independent risk factors for in-hospital mortality in RM patients with AKI.ConclusionsAKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of severe AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.

Abstract 15990: Incidence and Outcomes of Elevated Troponins in Patients With Rhabdomyolysis

Introduction: The relationship between rhabdomyolysis and elevated troponins has not been clearly established. Literature has been limited to case reports and small single center studies. However, there are no studies that evaluated the incidence and outcomes of troponin elevation in patients with rhabdomyolysis. Methods: Patients of 18 years and older with rhabdomyolysis were selected from the Healthcare Cost and Utilization Project National Inpatient Sample, 2005 to 2014. Patients with elevated troponins were identified. Information on demographics, co-morbidities and interventions (percutaneous coronary intervention (PCI) vs. no PCI) were extracted. The two main outcomes were mortality and hospital cost. Differences in characteristics and outcomes of patients with elevated troponins and those without elevated troponins were evaluated using descriptive analyses and multivariate regression models. Results: A total of 404,369 rhabdomyolysis participants were identified with 24,986 (6.18%) having elevated troponins. Of these, only 133 (0.03%) patients underwent PCI. Compared to the patients without elevated troponins, patients with elevated troponins were older (69y vs. 61y; P &lt;0.001), and the majority were white (73.9% vs. 66.0%; P &lt;0.001). In-hospital mortality in patients with elevated troponins was 20.5% compared to 5.4% in patients without elevated troponins ( P &lt;0.001) resulting in an adjusted odds ratio of 4.05 (95% CI: 3.90 - 4.20). Compared to the patients without elevated troponins, the median hospital cost in patients with elevated troponins was $17,308 vs. $8,434 ( P &lt;0.001) resulting in an adjusted mean difference of $9,547 (95% CI: $9,189 - $9,904). Conclusions: Our analysis showed that 6.1% of rhabdomyolysis patients have elevated troponins. Of these, very few patients underwent PCI, suggesting myocardial injury in these patients. Patients with elevated troponins had higher in-hospital mortality and increased cost of hospitalization. Due to the bad prognosis associated with elevated troponins, there is need for further evaluation for underlying coronary artery disease in patients with myocardial injury.

The Association Between Rhabdomyolysis, Acute Kidney Injury, Renal Replacement Therapy, and Mortality.

BackgroundWe examined the association between creatine phosphokinase level in rhabdomyolysis patients and risk of acute kidney injury, renal replacement therapy, and death within 30 days.MethodsThe cohort included patients admitted with rhabdomyolysis from November 1, 2011 to March 1, 2014. Rhabdomyolysis was defined as a creatine phosphokinase level higher than 1000 U/L. Information on laboratory variables was obtained from a laboratory database. Medical data were obtained from registries. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. The 30-day risk of outcomes was estimated using the cumulative incidence method. Spline regression applied to imputed datasets with adjustment for baseline variables was used to assess the appropriateness of the categorization chosen for creatine phosphokinase (1000–5000 U/L, 5001–15,000 U/L, and 15,000+ U/L).ResultsThe study included 1027 patients (58.2% male) with a median age of 73.5 years. The median creatine phosphokinase level at rhabdomyolysis diagnosis was 2257 U/L (interquartile range=1404–3961 U/L). The 30-day risks of acute kidney injury according to the three creatinine phosphokinase levels were 42% (95% CI=38–45%), 44% (95% CI=36–52%), and 74% (95% CI=57–85%), respectively, and the risks of renal replacement therapy for the three levels were 3% (95% CI=2–5%), 4% (95% CI=2–7%), and 11% (3–23%), respectively. The 30-day risk of death was 17% (95% CI=14–20%), 16% (95% CI=11–22%), and 11% (95% CI=3–23%), respectively. With increasing creatine phosphokinase levels, the spline plots supported the increasing risk of acute kidney injury and renal replacement therapy, as well as a decreasing risk of death. However, the risk estimates for renal replacement therapy and death were imprecise.ConclusionElevated initial creatine phosphokinase values were associated with an increased risk of acute kidney injury, while estimates of the risk of renal replacement therapy and death were imprecise.

P0632RISK FACTORS FOR ACUTE KIDNEY INJURE AMONG PATIENTS WITH RHABDOMYOLYSIS

Abstract Background and Aims Rhabdomyolysis (RM) is a syndrome characterized by the abruption of the integrity of skeletal muscle cells with subsequent release of intracellular components into extracellular fluid and circulation. Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis. The aim of this study was to assess patients at high risk for the occurrence of AKI defined by KDIGO criteria and in-hospital mortality. Method We performed a retrospective study of patients with creatine kinase levels in excess of 1000 U/L, admitted in West China Hospital of Sichuan University from January 2011 to march 2019. The sociodemographic, clinical and laboratory data of the patients were obtained in an electronic medical record database. Univariate and multiple regression analyses were conducted. Results 329 patients were included in our study. The incidence of AKI was 61.4%, the overall mortality was 19.8%, and patients with AKI tend to have higher mortality than those without AKI (24.8% versus 11.8%, P &amp;lt; 0.01). The clinical conditions most frequently associated with rhabdomyolysis were trauma (28.3%), infection (14.6%), bee stings (12.8%), thoracic and abdominal operations (11.2%) and exercise (7.0%). Patients resulted from sepsis, bee stings and acute alcoholism were susceptible to AKI. The risk factors for the occurrence of AKI among rhabdomyolysis patients included age≥60 (OR 3.070), chronic alcoholism (OR 3.256), hypertension (OR 4.252), multiple organ dysfunction syndrome (OR 7.244), elevated white blood cell counts (OR 1.047) and serum phosphorus (OR 5.526). Age≥60 (OR 3.188), multiple organ dysfunction syndrome (OR 2.262), diabetes (OR 2.746) and elevated prothrombin time (OR 1.079) were independent risk factors for in-hospital mortality of rhabdomyolysis patients with AKI. Conclusion AKI is independently associated with mortality in rhabdomyolysis patients. Several risk factors were found to be associated with the occurrence of AKI and in-hospital mortality. The findings aiming to suggest early prevention of AKI should target on patients with high risk and more effective management to improve the quality of medical care.

Immobilization-induced rhabdomyolysis patients with peripheral neuropathy: clinical, laboratory and imaging findings

Neuromuscular ultrasonography has emerged over the last decade as a useful tool for diagnosing peripheral nerve disorders. It has been studied extensively with a particular focus on the assessment of compression neuropathies. Neuromuscular ultrasonography complements electrodiagnostic studies well by visualizing both the nerve anatomy and surrounding structures, providing useful data that cannot be obtained using the latter methodology only. This review article summarizes and synthesizes the literature focusing on the diagnostic role of neuromuscular ultrasonography in common compression neuropathies of the upper limb. Key Words: Nerve compression syndromes · Ultrasonography · Upper extremity.

CrossFit and rhabdomyolysis: A case series of 11 patients presenting at a single academic institution

ObjectivesCrossFit is an increasingly popular high intensity work out program geared towards high repetition and intensity done in short intervals. Recently, documented cases of rhabdomyolysis (muscle necrosis and extreme muscle breakdown) after CrossFit participation have become increasingly concerning to physicians and participants alike. DesignRetrospective cohort study. MethodsAll patients who presented to the main hospital at a major academic center complaining of an injury sustained performing CrossFit between June 2010 and June 2016 were identified by the key phrases ‘CrossFit’, ‘crossfit’, ‘Crossfit’ or ‘cross fit’. Results523 patients incurred injuries associated with CrossFit activities. 11 patients presented to our institution ultimately received a diagnosis of rhabdomyolysis (2.1%). The average age of Rhabdomyolysis patient was 34.9 years, with 81.9% of patients being male. The average BMI was 24.2, and the average experience level was beginner (54.5%). The most common presenting symptom was dark urine (90.9%), followed by upper extremity pain (54.5%). Average symptom duration was 2.9days with 81.8% of patients presenting initially to the ED. The average hospital stay was roughly 2.9 days, and patients had an average of 1.44 clinical follow up visits. ConclusionCrossFit participation poses significant risks to participants including exercise induced rhabdomyolysis. Further study is needed in order to raise awareness of this issue and further quantify risk factors that may promote injury during participation.

A postpartum rhabdomyolysis patient due to hypothyroidism

Hypothyroidism can often cause muscle stiffness cramps myalgia and elevated muscle enzyme levels However rhabdomyolysis due to hypothyroidism during the postpartum period is rare In this article we aimed to present postpartum rhabdomyolysis due to hypothyroidism in a year old woman months after birth

The Use of Coupled Plasma Filtration Adsorption in Traumatic Rhabdomyolysis

Severe musculoskeletal injuries induce the release of sarcoplasmic elements such as muscle enzymes, potassium, and myoglobin in the systemic circulation. The circulating myoglobin damages the glomerulus and renal tubules. Conventional haemodialysis is not able to remove myoglobin, due to its high molecular weight (17,8 kilodaltons [kDa]). We treated four traumatic rhabdomyolysis patients with Coupled Plasma Filtration Adsorption (CPFA) in order to remove myoglobin followed by 14 hours of Continuous Veno-Venous Hemofiltration (CVVH). During the treatment, all patients showed clinical improvement with a decrease in muscular (creatine kinase [CK] and myoglobin) and renal (creatinine and potassium) damage indices. One patient, in spite of full renal recovery, died of cerebral haemorrhage on the 26th day of hospital stay.

Evaluation of rhabdomyolysis patients who opted for emergency services.

OBJECTIVE:Rhabdomyolysis is a clinical and biochemical syndrome caused by skeletal muscle injury. Our aim was to contribute to the existing data on rhabdomyolysis in our country by evaluating the etiologic, demographic, and clinical features of rhabdomyolysis patients who applied to a tertiary hospital emergency department.METHODS:We retrospectively evaluated the data of patients who applied to the tertiary hospital emergency department from January 2015 to January 2016. The study population comprised patients admitted to the emergency department of our hospital with creatinine kinase levels above 5000 U/L at admission. The data of all cases that were included in the study were scanned by the researchers using the hospital’s computer-based data recording system. Age, sex, creatine kinase levels, complaints, etiology, whether or not acute renal failure developed, hospitalization and discharge status, and clinic of hospitalization were screened for all patients.RESULTS:The creatine kinase levels of the patients at admission ranged from 5052 to 59140 U/L [median 7882 U/L (IQR: 7840)]. The most frequent (23.5%) cause of admission was extremity pain. The most common reason (19.6%) in the etiology was exercise. Twenty-one patients (41.1%) were admitted to clinics, and 1 patient (1.9%) died. Acute renal failure was observed in 4 patients (8.8%).CONCLUSION:Rhabdomyolysis is a clinical syndrome that can be life-threatening owing to muscle destruction. Although it is suspected after a traumatic injury, it should also be considered when other potential symptoms are observed. All clinicians should be aware of its common causes, diagnosis, and treatment options.

Automated Fluid Management for Treatment of Rhabdomyolysis.

Purpose. Fluid therapy aimed at increasing urine output is a commonly employed strategy to prevent acute kidney injury (AKI) in critically ill patients with rhabdomyolysis. Automated fluid management has the potential to optimise urine output while avoiding fluid accumulation in rhabdomyolysis patients. Methods. In a single centre clinical service evaluation we compared a convenience sample of critically ill adults with rhabdomyolysis treated with automated fluid management using the RenalGuard® device to patients managed with manual fluid adjustment following our standard rhabdomyolysis protocol. Primary outcome was number of hours with urine output >2 mL/kg during first 48 h of therapy. Results. Eight patients treated with RenalGuard were compared to 28 patients treated with manual fluid management. Number of hours of target urine output was greater in the RenalGuard versus the Standard group (176/312 (56.4%) versus 534/1305 (40.9%); p < 0.01). Urine output was significantly higher in the first 24 h in the RenalGuard group (median (IQR) 4033 mL (3682–7363) versus 2913 mL (2263–4188 mL); p < 0.01). Fluid balance, electrolyte, diuretics, and bicarbonate use were comparable between groups. Conclusions. Automated fluid management resulted in a higher urine output more quickly in the treatment of rhabdomyolysis. Further research is needed to analyse the effect of diuresis-matched hydration for the prevention of AKI in rhabdomyolysis.

Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South Italy

BackgroundAt present, prospectively collected data on rhabdomyolysis (RML) after bariatric surgery are limited. ObjectivesTo evaluate the incidence, risk factors, and therapeutic strategy of RML in different bariatric procedures. SettingUniversity hospitals, Italy. MethodsObese patients were prospectively enrolled. Preoperative demographic characteristics and clinical data, as well as type of anesthesia and type and total duration of surgery, were recorded as potential risk factors for RML. RML was defined as postoperative creatine kinase (CK)>1000 U/L. Incidence, possible risk factors, and therapeutic outcome of RML were assessed and compared with comparative groups. ResultsFour hundred eighty obese patients were included in the study. After surgery, RML was diagnosed in 62 (12.9%) patients. Muscular pain was present in 12 patients (19.3%). In RML patients, mean CK value was 1346±2132.5 U/L (range 1191–37,400). Only duration of surgery was identified as an independent risk factor for RML (P<.001). The best cutoff value of time as a predictor was 230 minutes. Aggressive therapy with fluids and diuretics started within 24 hours after surgery was more effective in relieving RML and muscle pain than a comparative retrospective group with a delayed diagnosis and therapy. ConclusionAfter bariatric surgery, the risk of RML increases, especially when the duration of surgery is>230 minutes. CK testing should be performed in all patients after bariatric surgery to make an early diagnosis and properly start fluids and diuretics.

Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis.

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. The present study was designed to analyse the specific features and mortality of patients with RB and the relation between creatinine, CK and mortality. 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. 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. 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.

BIOPSY PROVEN ACUTE TUBULAR NECROSIS DUE TO RHABDOMYOLYSIS IN A DENGUE FEVER PATIENT: A CASE REPORT AND REVIEW OF LITERATURE

Renal histology results are very scarce in dengue-associated rhabdomyolysis patients developing acute kidney injury (AKI). We report a case of dengue fever-induced AKI associated to rhabdomyolysis with a renal biopsy showing acute tubular necrosis (ATN) and renal deposition of myoglobin. A 28-year-old patient who presented dengue fever (DF) complicated by severe AKI and rhabdomyolysis is described. The patient required hemodialysis for three weeks. A renal biopsy revealed ATN with positive staining for myoglobin in the renal tubuli. The patient was discharged with recovered renal function. In conclusion, this case report described a biopsy proven ATN associated to DF-induced rhabdomyolysis, in which renal deposition of myoglobin was demonstrated. We suggest that serum creatine phosphokinase should be monitored in DF patients to allow for an early diagnosis of rhabdomyolysis and the institution of renal protective measures.

Kinetic modelling of haemodialysis removal of myoglobin in rhabdomyolysis patients

An extended two compartment model is proposed to describe the dynamics of myoglobin in rhabdomyolysis patients undergoing dialysis. Before using clinical data to estimate the model's unknown parameters, structural identifiability analysis was performed to determine the parameters uniqueness given certain clinical observations. A Taylor series expansion method was implemented which found that the model was structurally globally/uniquely identifiable for both on- and off-dialysis phases. The fitted model was then used in a predictive capacity showing that the use of Theralite high cut-off (HCO) or HCO 1100 dialyser gave a significant reduction in myoglobin renal exposure compared to standard haemodialysis (HD).

Incidence, Etiology, and Outcomes of Rhabdomyolysis in a Single Tertiary Referral Center

We have encountered numerous cases of rhabdomyolysis associated with acute pesticide intoxication; however, the cause, incidence, and treatment outcomes of rhabdomyolysis have not been studied. The current study involved 2,125 patients hospitalized with acute chemical poisoning. Based on clinical and laboratory parameters and treatment outcomes, we found that overall incidence of rhabdomyolysis in our hospital was 0.06% (93 of 143,830 patients admitted), but the incidence associated with acute pesticide intoxication was 1.8% (33 of 1,793 cases). The incidence of rhabdomyolysis after pesticide intoxication was significantly higher in men than in women (P = 0.010). The amount of pesticide ingested was significantly higher in rhabdomyolysis patients than that in those who did not develop rhabdomyolysis (mean ± SD, 114.1 ± 79.5 mL vs 74.1 ± 94.2 mL, P = 0.010). Our results show that pesticide intoxication is a frequent cause of rhabdomyolysis and is more common among men than women. The volume of pesticide ingested, and not the degree of human toxicity, is the main factor influencing the incidence of rhabdomyolysis.

Kinetic modelling of haemodialysis removal of myoglobin in rhabdomyolysis patients

Abstract A two compartment model is proposed to describe the dynamics of myoglobin in rhabdomyolysis patients undergoing dialysis. Before using clinical data to estimate the model's unknown parameters, structural identifiability analysis was performed to determine the parameters uniqueness given certain clinical observations. A Taylor series expansion method was implemented which found that the model was structurally globally/uniquely identifiable for both on- and off-dialysis phases. The fitted model was then used in a predictive capacity showing that the use of Theralite High Cut-off (HCO) or HCO 1100 dialyser gave a significant reduction in myoglobin renal exposure compared to standard haemodialysis (HD).

Serum Creatinine May Not Be an Accurate Marker of Glomerular Filtration Rate in Rhabdomyolysis Patient

PURPOSE: Creatine is released into the circulation after destruction of muscle cells in rhabdomyolysis patients. As excess circulating creatine forms creatinine, the serum creatinine (SCr) elevation in rhabdomyolysis patients may become disproportionate to the degree of reduction in glomerular filtration rate (GFR).