Rhabdomyolysis among critically ill combat casualties

Stewart, Ian J.; Faulk, Tarra I.; Sosnov, Jonathan A.; Clemens, Michael S.; Elterman, Joel; Ross, James D.; Howard, Jeffrey T.; Fang, Raymond; Zonies, David; Chung, Kevin K.

doi:10.1097/ta.0000000000000933

Cited by 38 publications

(21 citation statements)

References 29 publications

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“…Similarly, Sharp et al [ 3 ] found that an elevated serum CK value was a significant risk factor for AKI. Studies performed in war fighters have confirmed this association and have reported a positive correlation between AKI stages and higher CK values [ 4 , 15 ].…”

Section: Discussionmentioning

confidence: 83%

“…This result suggests a biologic gradient between worse renal function and mortality [ 24 , 33 ] and that the chances of death are proportional to the severity of AKI. Although we did not analyze the predictors of mortality in our series, it is important to mention the study by Stewart et al [ 15 ]. They examined a large cohort of combat casualties to identify risk factors for rhabdomyolysis and its relation to AKI and death.…”

Section: Discussionmentioning

confidence: 92%

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Acute kidney injury in severely injured patients admitted to the intensive care unit

García¹,

Manzano-Núñez

Bayona³

et al. 2020

Military Med Res

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Background Our objective was to identify possible associations between clinical and laboratory variables and the risk of developing acute kidney injury (AKI) in severely injured patients admitted to the intensive care unit (ICU) for whom creatine kinase (CK) levels were available. Methods For this retrospective observational study, we analyzed adult trauma patients admitted to the ICU from 2011 to 2015 at Fundación Valle del Lili (FVL) University Hospital. Our primary outcome was the incidence of AKI. Multivariate regression analysis was used to assess risk factors for this outcome. Results A total of 315 patients were included. The trauma mechanisms were blunt (n = 130), penetrating (n = 66) and blast (n = 44) trauma. The median (interquartile range, IQR) of injury severity score (ISS) was 21 (16–29). AKI developed in 75 patients (23.8%). Multivariate regression analysis revealed that the thoracic abbreviated injury scale (AIS) value (median (IQR) in the AKI group: 3 (0–4)), Acute Physiology and Chronic Health Evaluation (APACHE II) score (median (IQR) in the AKI group: 18 (10–27)), CK greater than 5000 U/L, lactic acid concentration at admission, and dobutamine administration were independently associated with AKI. Conclusion We found that age, APACHE II score, thoracic trauma, lactic acidosis, and dobutamine administration were independently associated with AKI. Trauma surgeons need to be aware of the increased odds of AKI if one of these factors is identified during the evaluation and treatment of injured patients.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 92%

Acute kidney injury in severely injured patients admitted to the intensive care unit

García¹,

Manzano-Núñez

Bayona³

et al. 2020

Military Med Res

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“…Our study supports evidence from previous observations. AKI has been reported to be associated with higher mortality in patients with all-cause and combat-injury-induced rhabdomyolysis [ 30 , 31 ]. Another important finding was that AKI is independently associated with the increased requirement of mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and the Impact of Acute Kidney Injury on Outcomes in Patients with Rhabdomyolysis

Yang

Dong

et al. 2021

JCM

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Background: Currently, no large, nationwide studies have been conducted to analyze the demographic factors, underlying comorbidities, clinical outcomes, and health care utilization in rhabdomyolysis patients with and without acute kidney injury (AKI). Methods: We queried the National Inpatient Sample of Healthcare Cost and Utilization Project (HCUP) with patients with rhabdomyolysis from 2016 to 2018. The chi-squared test was used to compare categorical variables, and the adjusted Wald test was employed to compare quantitative variables. The logistic regression model was applied to calculate adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) to estimate the impact of AKI on outcomes in patients with rhabdomyolysis. Results: Among 111,085 rhabdomyolysis-related hospitalizations, a higher prevalence of AKI was noticed in older patients (mean age ± SD, 58.2 ± 21.6 vs. 53.8 ± 22.2), Medicare insurance (48.5% vs. 43.2%,), and patients with a higher Charlson Comorbidity Index score (CCI 3–5, 15.1% vs. 5.5%). AKI was found to be independently associated with higher mortality (adjusted odds ratio [aOR].3.33, 95% CI 2.33–4.75), longer hospital stays (adjusted difference 1.17 days, 95% CI: 1.00−1.34), and higher cost of hospital stay (adjusted difference $11,315.05, 95% CI: $9493.02–$13,137.07). Conclusions: AKI in patients hospitalized with rhabdomyolysis is related to adverse clinical outcomes and significant economic and survival burden.

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“…Delayed recognition and treatment of sepsis; the unavailability of diagnostics tools or a higher level of care; limited access to antivenom and antibiotics, including highly active antiretroviral therapy; and the inability to provide timely and monitored management of hyperkalemia, acidosis, and fluid overload with diuretics increase AKI incidence, likely escalate the requirements for dialysis treatment, and lead to higher mortality. 13 , 14 Tropical infections, 16 , 21 community-acquired pneumonia or meningitis, pregnancy-related complications (bleeding, eclampsia, septic abortion), 22 , 23 , 24 , 25 , 26 dehydration due to inadequate access to fluids in frail older adults and young children, exposure to nephrotoxins (e.g., nonsteroidal anti-inflammatory drugs, calcineurin blockers, antiretroviral therapy, antibiotics, or contrast media), 27 , 28 , 29 poisons (e.g., arsenic poisoning), 30 drug interactions (e.g., calcium-channel blocker plus clarithromycin), 31 animal venoms (e.g., snake venom), 20 trauma-induced rhabdomyolysis, 32 and shock states due to heart failure, hypovolemia, or sepsis 1 , 16 , 33 are all factors that can result in AKI. AKI following polypharmacy and nephrotoxin exposures in developing countries may be more prevalent, particularly when oversights of pharmacies are not robust due to more limited resources.…”

Section: Methodsmentioning

confidence: 99%

Acute Kidney Injury Risk Assessment: Differences and Similarities Between Resource-Limited and Resource-Rich Countries

Kashani

Macedo

Burdmann

et al. 2017

Kidney International Reports

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The incidence of acute kidney injury (AKI) among acutely ill patients is reportedly very high and has vexing consequences on patient outcomes and health care systems. The risks and impact of AKI differ between developed and developing countries. Among developing countries, AKI occurs in young individuals with no or limited comorbidities, and is usually due to environmental causes, including infectious diseases. Although several risk factors have been identified for AKI in different settings, there is limited information on how risk assessment can be used at population and patient levels to improve care in patients with AKI, particularly in developing countries where significant health disparities may exist. The Acute Disease Quality Initiative consensus conference work group addressed the issue of identifying risk factors for AKI and provided recommendations for developing individualized risk stratification strategies to improve care. We proposed a 5-dimension, evidence-based categorization of AKI risk that allows clinicians and investigators to study, define, and implement individualized risk assessment tools for the region or country where they practice. These dimensions include environmental, socioeconomic and cultural factors, processes of care, exposures, and the inherent risks of AKI. We provide examples of these risks and describe approaches for risk assessments in the developing world. We anticipate that these recommendations will be useful for health care providers to plan and execute interventions to limit the impact of AKI on society and each individual patient. Using a modified Delphi process, this group reached consensus regarding several aspects of AKI risk stratification.

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Rhabdomyolysis among critically ill combat casualties

Abstract: Prognostic and epidemiologic study, level III.

Cited by 38 publications

References 29 publications

Acute kidney injury in severely injured patients admitted to the intensive care unit

Acute kidney injury in severely injured patients admitted to the intensive care unit

Epidemiology and the Impact of Acute Kidney Injury on Outcomes in Patients with Rhabdomyolysis

Acute Kidney Injury Risk Assessment: Differences and Similarities Between Resource-Limited and Resource-Rich Countries

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