Predictive value of serum myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis

Abstract

Introduction:Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM.Methodology:A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with “crush protocol.” Daily/twice a day, serum CPK and myoglobin were estimated. Categorical data are expressed as frequency and percentage, and the continuous variables are presented as mean (standard deviation) or median (interquartile range) based on normality. Other statistical analyses were done using the Chi-square test, independent t-test, and rank sum test based on normality.Results:Fourteen out of 90 patients developed AKI and one patient required renal replacement therapy. CPK value of >12,000 U/l was identified to have 64% sensitivity and 56% specificity for developing AKI whereas serum myoglobin value of >5000 ng/ml was identified to have 78% sensitivity and 77% specificity for developing AKI.Conclusion:Following traumatic RM, in patients on “crush protocol,” serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI.

Illicit drug use and acute kidney injury in patients admitted to hospital with rhabdomyolysis

“…We were unable to establish an association between myoglobinuria and AKI due to the lack of uniform testing for urinary myoglobin. However, several studies have demonstrated that serum myoglobin is a better predictor of AKI than serum CK . One study which compared CK, urine myoglobin and serum myoglobin noted that although all three markers significantly correlated with AKI, serum myoglobin had the best area under the receiver operating curve for predicting AKI .…”

“…However, several studies have demonstrated that serum myoglobin is a better predictor of AKI than serum CK. [13][14][15][16] One study which compared CK, urine myoglobin and serum myoglobin noted that although all three markers significantly correlated with AKI, serum myoglobin had the best area under the receiver operating curve for predicting AKI. 16 Furthermore, a systematic review found insufficient evidence for using urine myoglobin to predict AKI, and serum and urine myoglobin results can be discrepant.…”

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

“…The study primary endpoint was AKI (any stage of the KDIGO classification) over the first admission week. The secondary endpoints were AKI stage 2 or 3 and the occurrence of severe rhabdomyolysis as defined by a peak of myoglobin higher than 5000 μg/L as stated in several studies [22,23] or a peak of CK higher than 5000 U/L as proposed in the statement on prevention and management of acute renal failure in the ICU" published in 2010 [24] over the first 7 days of admission.…”

Rhabdomyolysis Causing Renal Failure Following Cardiopulmonary Resuscitation, Cardioversion, and Myocardial Infarction: A Case Report and Review of the Literature

“…Studies have shown that serum CK higher than 16,000 U/L are more likely to be associated with renal failure [12][13][14]. Raju et al [15] concluded that myoglobin is more higher sensitive test than serum CPK in predicting impending renal failure. The graphic representation of serum myoglobin and CK ( Figure 1) demonstrates how myoglobin peaked before CK in our patient.…”