Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma
Purpose Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (crea...
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| Language: | English |
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Korean Society of Traumatology
2019-03-01
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| Series: | Journal of Trauma and Injury |
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| Online Access: | http://www.jtraumainj.org/upload/pdf/jti-32-026.pdf |
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| _version_ | 1841558903626661888 |
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| author | Jung Yun Park Myoung Jun Kim Jae Gil Lee |
| author_facet | Jung Yun Park Myoung Jun Kim Jae Gil Lee |
| author_sort | Jung Yun Park |
| collection | DOAJ |
| description | Purpose Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ≥5,000) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1–3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters. Methods We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ≥1,000 U/L and ≥5,000 U/L, respectively. The diagnosis of AKI was based on RIFLE criteria. Results The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L. Conclusions Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation. |
| format | Article |
| id | doaj-art-3c2967805fc3455bad853318846a3634 |
| institution | Kabale University |
| issn | 1738-8767 2287-1683 |
| language | English |
| publishDate | 2019-03-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-3c2967805fc3455bad853318846a36342025-01-06T01:15:42ZengKorean Society of TraumatologyJournal of Trauma and Injury1738-87672287-16832019-03-01321263110.20408/jti.2018.029975Early Predictive Values for Severe Rhabdomyolysis in Blunt TraumaJung Yun Park0Myoung Jun Kim1Jae Gil Lee2Department of Surgery, Yonsei University College of Medicine, Seoul, KoreaDepartment of Surgery, Yonsei University College of Medicine, Seoul, KoreaDepartment of Surgery, Yonsei University College of Medicine, Seoul, KoreaPurpose Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ≥5,000) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1–3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters. Methods We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ≥1,000 U/L and ≥5,000 U/L, respectively. The diagnosis of AKI was based on RIFLE criteria. Results The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L. Conclusions Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation.http://www.jtraumainj.org/upload/pdf/jti-32-026.pdfrhabdomyolysiscreatine kinaseacute kidney injury |
| spellingShingle | Jung Yun Park Myoung Jun Kim Jae Gil Lee Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma Journal of Trauma and Injury rhabdomyolysis creatine kinase acute kidney injury |
| title | Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma |
| title_full | Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma |
| title_fullStr | Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma |
| title_full_unstemmed | Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma |
| title_short | Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma |
| title_sort | early predictive values for severe rhabdomyolysis in blunt trauma |
| topic | rhabdomyolysis creatine kinase acute kidney injury |
| url | http://www.jtraumainj.org/upload/pdf/jti-32-026.pdf |
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