Admission serum myoglobin and the development of acute kidney injury after major trauma

Abstract

Background Myoglobin and creatine kinase (CK) are both established markers of muscle injury but their hospital admission values have never been compared to predict post-traumatic acute kidney injury (AKI). Methods An observational registry study of consecutive trauma patients admitted to a major regional trauma centre. The primary outcome was stage 1 or more AKI in the first 7 days after trauma. We assessed the association of hospital admission myoglobin or CK with development of AKI both alone and when added to two existing risk prediction models for post traumatic AKI. Results Of the 857 trauma patients (median age 36 [25–52], 96% blunt trauma, median ISS of 20 [12–47]) included, 102 (12%) developed AKI. Admission myoglobin performed better than CK to predict AKI any stage with an AUC–ROC of 0.74 (95% CI 0.68–0.79) and 0.63 (95% CI 0.57–0.69), respectively (p < 0.001). Admission myoglobin also performed better than CK to predict AKI stage 2 or 3 [AUC–ROC of 0.79 (95% CI 0.74–0.84) and 0.74 (95% CI 0.69–0.79), respectively (p < 0.001)] with a best cutoff value of 1217 µg/L (sensitivity 74%, specificity 77%). Admission myoglobin added predictive value to two established models of AKI prediction and showed significant ability to reclassify subjects regarding AKI status, while admission CK did not. Decision curve analysis also revealed that myoglobin added net benefit to established predictive models. Admission myoglobin was better than CK at predicting development of significant rhabdomyolysis. Conclusions Admission myoglobin better predicts the development of AKI and severe rhabdomyolysis after major trauma. Admission myoglobin should be added in established predictive models of post-traumatic AKI to early identify high-risk patients.

Study of the Relationship Between Liver Function Markers and Traumatic Rhabdomyolysis: A Retrospective Study of Hemorrhagic Patients Admitted to Intensive Care Unit in a Level I Trauma Center

“…www.anesthesia-analgesia.org 845 years old, and almost 75% of the patients were male. Patients were severely injured, with a median ISS of 26 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). RM was highly prevalent in the global cohort (58.1%), and 55 (23.2%) patients presented with intense RM.…”

“…In contrast, several studies have reported a prevalence of intense traumatic RM (CK >5000 U/L) at 13% to 31%, which is consistent with our results. 32–36…”

Trauma‐related electrolyte disturbances: From resuscitation to rhabdomyolysis

“…76,78,79 Serum CK levels rise within 12 h of injury and peak in 24−72 h, which makes it more useful than myoglobin for diagnosing rhabdomyolysis, 71,80 but there are still conflicting data on whether CK levels correlate with progression to renal failure and clear cutoffs have not been established prospectively. 75,[81][82][83] Similarly, the evidence regarding serum myoglobin levels for prognostication in rhabdomyolysis is also mixed. 78,82,84 Regardless, once the diagnosis of rhabdomyolysis has been made, the most important next steps include identifying high-risk features and proactively treating the physiologic and metabolic disturbances associated with this syndrome.…”

“…75,[81][82][83] Similarly, the evidence regarding serum myoglobin levels for prognostication in rhabdomyolysis is also mixed. 78,82,84 Regardless, once the diagnosis of rhabdomyolysis has been made, the most important next steps include identifying high-risk features and proactively treating the physiologic and metabolic disturbances associated with this syndrome. An in-depth review of the treatment of rhabdomyolysis is outside of the scope of this article but several recent publications are available for the reader for review.…”

“…Renal failure in rhabdomyolysis is attributed to the nephrotoxic effects of myoglobin on renal tubules but myoglobin's half‐life (2–3 h) makes it unreliable for diagnostic purposes because it can be completely cleared within 24 h of injury 76,78,79 . Serum CK levels rise within 12 h of injury and peak in 24−72 h, which makes it more useful than myoglobin for diagnosing rhabdomyolysis, 71,80 but there are still conflicting data on whether CK levels correlate with progression to renal failure and clear cutoffs have not been established prospectively 75,81–83 . Similarly, the evidence regarding serum myoglobin levels for prognostication in rhabdomyolysis is also mixed 78,82,84 .…”