Rhabdomyolysis in Critically Ill Patients With COVID-19: A Retrospective Study

Abstract

Introduction: The total number of ICU admissions for COVID-19 patients has increased steadily. Based on the research team's clinical observations, many patients developed rhabdomyolysis, but few cases were reported in the literature. This study explores the incidence of rhabdomyolysis and its outcomes, like mortality, the need for intubation, acute kidney injury, and the need for renal replacement therapy (RRT).Methods: We retrospectively reviewed the characteristics and outcomes of patients admitted to the ICU at a COVID-19-designated hospital in Qatar between March and July 2020. Logistic regression analysis was used to determine factors associated with mortality.Results: 1079 patients with COVID-19 were admitted to the ICU, and 146 developed rhabdomyolysis. Overall, 30.1% died (n = 44), and 40.4% developed Acute Kidney Injury (AKI) (n = 59), with only 19 cases (13%) recovering from the AKI. AKI was significantly associated with increased mortality rates among rhabdomyolysis patients. Moreover, significant differences were found between groups regarding the subject's age, calcium level, phosphorus level, and urine output. However, the AKI was the best predictor of mortality for those who got the COVID-19 infection and rhabdomyolysis. Conclusion: Rhabdomyolysis increases the risk of death in COVID-19 patients admitted to the ICU. The strongest predictor of a fatal outcome was acute kidney injury. The findings of this study emphasize the importance of early identification and prompt treatment of rhabdomyolysis in patients with severe COVID-19.

Profound Rhabdomyolysis and Viral Myositis Due to SARS-CoV-2: A Case Report

“…If rashes had been present, for example, a dermatomyositis would be suspected [ 4 ]. Rhabdomyolysis with SARS-CoV-2 is associated with higher rates of ICU admission, mechanical ventilation, and mortality [ 1 , 3 ]. Persistent fatigue and myalgias have been reported as the long-term debilitating symptoms of the condition [ 8 ], which our patient fortunately did not endure and had a good clinical response likely due to young age and absence of comorbid risk factors.…”

“…As many as 2.2% of patients affected with SARS-CoV-2 may have rhabdomyolysis, a condition characterized by the breakdown of skeletal muscle [ 1 ] and may be a specific subtype of viral myositis [ 2 ]. It is important to recognize this condition due to mortality rates as high as 30% [ 3 ]. In the setting of acute kidney injury (AKI), fatality can be as high as 40% [ 3 ].…”

“…It is important to recognize this condition due to mortality rates as high as 30% [ 3 ]. In the setting of acute kidney injury (AKI), fatality can be as high as 40% [ 3 ]. Certainly, rhabdomyolysis seems to be associated with higher risks of decompensation, such as intensive care unit (ICU) admission (90.9%), compared to medical and stepdown comparators (p < 0.001) and mechanical ventilation (86.4%) (p < 0.001) [ 1 ].…”

SARS-CoV-2 and its Multifaceted Impact on Bone Health: Mechanisms and Clinical Evidence

“…Systemic inflammation, prevalent in these conditions, intensifies muscle degradation, with cytokines both promoting protein breakdown and hampering muscle regeneration [ 86 – 88 ]. One study observed that in 146 COVID-19 patients who developed rhabdomyolysis, approximately 30% died and 40% developed AKI, indicating the systemic effects of muscle breakdown can result in severe consequences for COVID-19 patients [ 89 ].…”

COVID-19 and Bone Loss: A Review of Risk Factors, Mechanisms, and Future Directions

“…The diffuse myositis observed with SARS-CoV-2 infection and the failure to consistently identify viral particles in myocytes suggests that the myositis is a result of the “cytokine storm” brought on by the infection. When the myositis is severe, the myoglobin released from muscle breakdown can cause a form of kidney failure referred to as rhabdomyolysis [ 95 – 98 ]. The effects of acute kidney failure with SARS-CoV-2 infection will be discussed in a later section.…”