Late-onset rhabdomyolysis in burn patients in the intensive care unit

Bache, Sarah E.; Taggart, Ian; Gilhooly, Charlotte

doi:10.1016/j.burns.2011.05.014

Cited by 10 publications

(6 citation statements)

References 42 publications

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“… AKI developed in only nine patients Lagandre et al 2006 [ 17 ] POS 49 bariatric post-operative patients CK level >1000 IU/L NA Surgical time >4 h, diabetes, BMI >40 kg/m 2 RM = 13 Type of surgeries performed were gastric banding or bypass De Oliveira et al 2009 [ 18 ] POS 22 bariatric post-operative patients An increase >5× the upper limit of the normal CK level NA Prolonged surgical duration RM = 17 Clinical neuromuscular symptoms occurred in 45 % of patients Linares et al 2009 [ 19 ] RS Hospitalized patients CK levels >5000 IU/L Recreational drugs and alcohol, trauma, compression, shock and statin use NA RM = 106 The authors suggest that RM should be defined using CK levels above 10–25 times the upper limit of normal. AKI developed in 52 patients Youssef et al 2010 [ 20 ] POS 23 bariatric post-operative patients Post-operative CK levels >1000 IU/L NA BMI >56 kg/m 2 RM = 7 Factors such as sex, age, and length of surgery were not good predictors of RM Alpers et al 2010 [ 21 ] RS Patients in military training Muscle pain, weakness, or swelling over <7 days with a CK >5× the upper limit of normal Exertional RM NA RM = 177 Authors comment that exertional RM is associated with lower incidence of AKI Bache et al 2011 [ 22 ] RS 76 burn patients in the ICU “Late-onset” RM: CK >1000 U/L, 1 week or more after burn episode NA Sepsis, nephrotoxic drugs, hypokalemia “Late-onset” RM = 7 Authors suggest measuring CK in all patients with the risk factors described in burn patients to initiate prompt treatment Oshima 2011 [ 23 ] RS Cases of drug-related RM NA Drug use <10 year olds, weight less than 50 kg RM = 8610 …”

Section: Resultsmentioning

confidence: 99%

Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice

et al. 2016

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BackgroundRhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis.MethodsA systematic search was conducted using the keywords “rhabdomyolysis” and “crush syndrome” covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics.ResultsThe search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis.ConclusionMost studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.

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Section: Resultsmentioning

confidence: 99%

Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice

et al. 2016

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“…However, a 10-year retrospective review of 714 severely burned patients revealed a 1% incidence of rhabdomyolysis [17]. A smaller retrospective study found the incidence of late-onset rhabdomyolysis to be as high as 9% in severely burned patients [18]. Rhabdomyolysis has been described in the setting of skin necrosis associated with injection drug use [19]; however, larger trials and case series are lacking.…”

Section: Discussionmentioning

confidence: 99%

Autologous Creatinine Clearance in a Case of Necrotizing Fasciitis and Anuria

Eadon

Koyner

2012

Am J Nephrol

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Necrotizing fasciitis can present with concomitant acute kidney injury. The etiology of acute kidney injury is often multifactorial; potential sources include volume depletion, abdominal compartment syndrome, rhabdomyolysis, and acute tubular necrosis (which may be related to hemodynamic instability, medications, or sepsis/infection). Kidney injury, defined via changes in serum creatinine, portends increased morbidity and mortality. Thus, it is crucial to accurately diagnose and assess the severity of kidney injury. We present the case of a patient with necrotizing fasciitis who endured 31 consecutive days of complete anuria. His serum creatinine decreased over this interval without the use of extracorporeal hemofiltration or dialysis. The explanation for this novel phenomenon lies in massive daily sero-sanguineous discharge and insensible losses with subsequent volume resuscitation. The patient's own convective clearance was substantial enough to maintain a modest creatinine clearance of 15 ml/min during sustained anuria. Our case emphasizes the importance of employing the creatinine, estimated glomerular filtration rate, and urine output portions of the Acute Kidney Injury Network (AKIN) or Risk Injury Failure Loss End stage (RIFLE) criteria in assessing the severity of kidney injury. It further reinforces the imperfection in using serum creatinine as a primary measure of glomerular filtration rate.

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“…En pacientes quemados, el desarrollo de AKI como complicación, determina un deterioro en el pronóstico final con reportes de mortalidad tan altos que varían entre un 50% -100% (4-13, 32, 33). La lesión renal aguda en los pacientes quemados tiene presentaciones temporales de origen diferente (48,10). La lesión renal aguda que se presenta en la primera semana (AKI temprana o tAKI), está asociada al choque del quemado, inadecuada reanimación hídrica, vasoconstricción periférica, bajo gasto cardiaco o a la presencia de rabdomiólisis (32,49).…”

Section: Lesión Renal Aguda En El Paciente Quemadounclassified

“…La que se presenta luego del quinto a séptimo día (AKI tardío), se relaciona a complicaciones como sepsis, SDRA, SDMO y uso de medicamentos nefrotóxicos como algunos antibióticos. Tanto la lesión renal aguda temprana como la tardía, presentan mortalidad igualmente elevada (48,50).…”

Section: Lesión Renal Aguda En El Paciente Quemadounclassified

“…Un reciente realizado por Stewart et al, evaluó la presencia de rabdomiólisis en quemaduras de todas las causas, demostrando una asociación importante del valor pico de CPK con la presencia de AKI o muerte (94). En estudios en otras poblaciones de pacientes críticos se ha determinado valores mayores de 5.000 UL/lL de CPK, como valores clínicamente importantes (48,57,95). En el estudio específico de Steward, un punto de corte tan bajo como 3.925 UI/L, representaba un riesgo >50% para presentar estadio avanzado de AKI o muerte (94).…”

Section: Discusionunclassified

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Lesión renal aguda temprana en pacientes adultos con lesiones eléctricas score de predicción

Navarrete¹

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Introducción: La lesión renal aguda (AKI) en pacientes quemados, expresada por oliguria transitoria y/o pequeñas elevaciones de creatinina, es asociada con incremento en la mortalidad. En las lesiones eléctricas, la destrucción muscular profunda produce el síndrome de Rabdomiolisis. L« lesión renal aguda mioglobinurica es una complicación que puede ser fatal. El objetivo del estudie fue establecer la incidencia de AKI temprano (tAKI) en la primera semana post trauma eléctrico \ desarrollar y validar un puntaje de predicción de riesgo (PRS). Metodología: Cohorte retrospectiva de pacientes adultos, hospitalizados en las primeras 48 horas posterior al trauma eléctrico, durante el periodo de Enero 2007 a Diciembre de 2013. El desenlace fue definido por los criterios de Acutí Kidney Injury Network (AKIN). Un modelo de regresión logística multivariable fue derivado. Un PR! paro estimar tAKI fue desarrollado utilizando los coeficientes 0 contraídos. Resultados: De pacientes estudiados, 5.5% desarrollaron tAKI. El género no fue asociado a tAKI. La CPK mayor que 15.001 Ul/L es asociado en el análisis univariable, pero no el multivariable. Se obtuvieron cuatrmenor que predictores independientes. La prueba de bondad de ajuste de Hosmer-Lemeshow fue 0.844. E índice general de clasificación fue 94.6%. El área bajo la curva ROC fue 0.789. No hubo diferencia entre los coeficientes obtenidos del modelo multivariable y los obtenidos por técnica de remuestreo. El área ROC fue 0.787 en el proceso de validación del modelo. Los factores de riesgo constituyen e TBSA, Age, Compartí mental syndrome, Hypotension: (TACHY score). La probabilidad de tAKI estimada comparada con la observada fue similar en las cuatro categorías de riesgo. Conclusiones El riesgo de tAKI en quemaduras eléctricas se puede predecir rápidamente por el puntaje de riesgo TACHY

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Late-onset rhabdomyolysis in burn patients in the intensive care unit

Cited by 10 publications

References 42 publications

Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice

Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice

Autologous Creatinine Clearance in a Case of Necrotizing Fasciitis and Anuria

Lesión renal aguda temprana en pacientes adultos con lesiones eléctricas score de predicción

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