Rhabdomyolysis (RM) is a clinical and laboratory syndrome with the underlying destruction of myocytes and the release of intracellular debris into the systemic circulation. In more than 55% of cases, RM is complicated by acute kidney injury (AKI), which necessitates various methods of extracorporeal detoxification and currently is a controversial issue.Aim: to improve the results of treatment of patients with RM of toxic origin complicated by AKI by using early selective hemoadsorption (SH).Material and methods. The study included 36 patients divided into 2 groups. Group 1 included 24 patients who received standard therapy and hemodiafiltration (HDF) as a life-saving intervention. Group 2 comprised 12 patients who underwent early SH to prevent the progression of AKI. We performed a comparative analysis of clinical and laboratory parameters and treatment outcomes in the groups.Results. The use of SH was associated with reduced level of myoglobin on day5 of therapy from 384.1 to 112.4 gg/l (70.7%) vs 335.15 to 219.1 gg/l (34.6%) reduction in the conservative therapy group. By day 7, this parameter was 18.8 (95.1%) and 142.4 (57.5%), respectively (7=0.012). The level of cystatin-C decreased on day 5 from 17.3 to 3.2 mg/l (81.5%) in group 2 and from 14.9 to 11.7 mg/l (21.5%) in group 1. By day 7, this parameter decreased to 2.5 (85.6%) and 14.1 (5.3%) mg/l, respectively (7=0.001). The length of ICU stay in group 2 was 7 (6; 9) days, while in the conservative therapy group it was 12 (7; 13) days (7=0.04). The hospital stay was 12 (10; 16) and 22 (14,5; 24,5) days, respectively (7=0.028).Conclusion. The early use of SH in the intensive therapy helped decrease the levels of markers of endogenous intoxication, AKI severity, improve the filtration capacity of the kidneys, and reduced the length of stay in the ICU and hospital.
Introduction. The prevalence of rhabdomyolysis among people admitted to the hospital due to acute poisoning reaches, according to various foreign sources, from 30 to 40%. In 60% of cases, the development of rhabdomyolysis in adult patients is associated with acute exogenous intoxication. Currently, data on the prevalence, structure and outcomes of treatment of rhabdomyolysis in toxicological patients are mainly presented by the results of foreign clinical and epidemiological studies. The aim is to study the prevalence, structure, frequency of complications and outcomes of treatment of rhabdomyolysis in acute exogenous intoxication in a multidisciplinary hospital. Material and methods. The study included 1,363 patients who were treated from 2017 to 2020 with acute exogenous intoxication. During the study, 98 patients with rhabdomyolysis were selected from the general group. The frequency of poisoning with various toxicants was analyzed, the effects of which led to the development of rhabdomyolysis in acute exogenous intoxication. The incidence of acute kidney injury (AKI) was detected, the outcomes of acute poisoning treatment, the duration of inpatient treatment were determined, and a comparative analysis was carried out between groups of patients with rhabdomyolysis in acute exogenous intoxication (n=98) and without it (n=1265). Results. The prevalence of rhabdomyolysis among patients hospitalized for acute poisoning was 7%. The main reason for the development of rhabdomyolysis was the use of narcotic drugs - 87% of cases. The development of rhabdomyolysis in acute exogenous intoxication in 59.2% of cases is accompanied by the occurrence of AKI, which is significantly higher than among patients without rhabdomyolysis (11.6%). The occurrence of rhabdomyolysis in toxicological patients increases hospital mortality from 6.1 to 10.2%, as well as the duration of inpatient treatment and intensive care by 5.2 and 3.3 days, respectively. Limitations. The study was conducted based on only one multidisciplinary hospital in Moscow in the period from 2017 to 2020. Conclusion. Rhabdomyolysis is a serious complication of acute poisoning, the development of which significantly worsens the outcomes of treatment of patients with a toxicological profile, which requires the development of effective methods for the prevention, diagnosis and treatment of rhabdomyolysis in acute exogenous intoxication.
АКТУАЛЬНОСТЬ. Рабдомиолиз (РМ) встречается у 40–60 % пациентов с острыми отравлениями и сопровождается острым почечным повреждением (ОПП). Наиболее эффективным методом лечения представляется применение экстракорпоральной детоксикации. Наиболее перспективными являются комбинированные методы детоксикации. ЦЕЛЬ ИССЛЕДОВАНИЯ. Улучшить результаты лечения пациентов с токсическим РМ, осложненным ОПП, путем раннего применения селективной гемосорбции и гемодиафильтрации. МАТЕРИАЛЫ И МЕТОДЫ. В исследование включены 57 пациентов с РМ токсического генеза, осложненным ОПП. В 1-й группе проводили стандартную интенсивную терапию. Для лечения 2-й группы на ранней стадии ОПП применяли гемодиафильтрацию и селективную гемоперфузию. Выполняли сравнительный анализ динамики основных клинических и лабораторных показателей, а также исходов лечения между группами. РЕЗУЛЬТАТЫ. Применение селективной гемоперфузии и гемодиафильтрации на ранней стадии ОПП позволило увеличить снижение уровня миоглобина в крови с 26,3 до 88,0 % и KIM-1 в моче с 76,1 до 99,0 % в течение первой недели лечения в отделении реанимации и интенсивной терапии (ОРИТ). Проведение комбинированной детоксикации снизило продолжительность применения заместительной почечной терапии с 15 до 6 сут, что привело к достоверному снижению уровня госпитальной летальности с 14,3 до 6,9 %, сроков стационарного лечения с 19,5 до 11 сут и периода пребывания в ОРИТ с 11 до 4 сут. ВЫВОДЫ. Раннее применение комбинированной экстракорпоральной детоксикации приводит к существенному снижению уровня факторов эндогенной интоксикации, что в итоге позволило уменьшить сроки лечения в ОРИТ, стационаре и снизить уровень госпитальной летальности.
The objective: to improve treatment results in patients with toxic rhabdomyolysis (RM) complicated by acute kidney injury (AKI) through using selective hemoperfusion (НР).Subjects and Methods. The study included 45 patients aged 18 to 55 years diagnosed with toxic RM complicated by AKI. The patients were divided into two groups. Group 1 received standard conservative therapy. In Group 2, during the first day of treatment, HP was used to prevent AKI progression. Changes in clinical and laboratory parameters of RM and renal damage as well as treatment outcomes between the groups were analyzed and compared.Results. Significantly better decrease in myoglobin blood level was revealed in Group 2 from day 1 to day 7 of treatment. In Groups 1 and 2, these parameters made 26.3% and 52.1%, respectively. The use of НР allowed reducing the urine concentration of KIM-1 by day 3 of treatment in Group 2 by 16.9%, in Group 1, the urine concentration of KIM-1 increased by 15.5%. The frequency of RRT initiation for urgent indications decreased from 75% to 52.9% when using HP, as a result, duration of inpatient treatment decreased from 19.5 (14; 22) to 16.5 (13; 19) days, as well as the period of ICU stay from 11 (9; 15) to 8 (6; 11) days.Conclusions. The early use of НР as part of the complex intensive therapy of toxic RM complicated by the development of AKI is accompanied by an earlier and significant decrease in laboratory markers of RM and AKI compared to standard treatment, as well as shorter ICU and hospital stay
Российский национальный исследовательский медицинский университет им. Н. И. Пирогова, Москва, РФ Рабдомиолиз (РМ) -клинико-лабораторный синдром, сопровождающийся системным эндотоксикозом вследствие деструкции миоцитов и проявляющийся острым почечным повреждением (ОПП)� Применение экстракорпоральной детоксикации на ранних этапах ОПП в настоящее время не получило признания вследствие отсутствия доказанной эффективности� Цель исследования: демонстрация эффективности применения селективной гемосорбции (СГ) и гемодиафильтрации (ГДФ) у пациента с токсическим РМ, осложненным ОПП� Материалы и методы: клиническое наблюдение пациента 18 лет после употребления 4-метилметкатинона (мефедрон) с развитием ОПП� Использовали клинико-лабораторные, диагностические, токсикологические и инструментальные методы обследования� Совместно со стандартной интенсивной терапией применяли СГ и ГДФ�
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