Rhabdomyolysis: risk factors and incidence in polytrauma patients in the absence of major disasters

Sousa, Alexandra; Paiva, José Artur; Fonseca, Sofia; Raposo, Frederico; Valente, Luís; Vyas, Dharmesh; Ribeiro, Orquídea; Pinto, Rui

doi:10.1007/s00068-012-0233-7

Cited by 12 publications

(7 citation statements)

References 42 publications

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“…Rhabdomyolysis describes the disintegration of skeletal muscles, leading to the release of muscle components into the blood [1]. The most common cause is traumatic damage of the muscles, for example in patients after multiple traumas [2]. However, the clinical picture can also occur as part of severe sepsis and due to drug side effects [3].…”

Section: Introductionmentioning

confidence: 99%

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

et al. 2021

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Background Rhabdomyolysis is frequently occurring in critically ill patients, resulting in a high risk of acute kidney injury (AKI) and potentially permanent kidney damage due to increased myoglobin levels. The extracorporeal elimination of myoglobin might be an approach to prevent AKI, but its molecular weight of 17 kDa complicates an elimination with conventional dialysis membranes. Question of interest is, if myoglobin can be successfully eliminated with the cytokine adsorber Cytosorb® (CS) integrated in a high-flux dialysis system. Methods Patients were included between 10/2014 and 05/2020 in the study population if they had an anuric renal failure with the need of renal replacement therapy, if CS therapy was longer than 90 min and if myoglobin level was > 5.000 ng/ml before treatment. The measurement times of the laboratory values were: d-1 = 24–36 h before CS, d0 = shortly before starting CS and d1 = 12–24 h after starting CS treatment. Statistical analysis were performed with Spearman’s correlation coefficient, Wilcoxon test with associated samples and linear regression analysis. Results Forty-three patients were included in the evaluation (median age: 56 years, 77% male patients, 32.6% ECMO therapy, median SAPS II: 80 points and in-hospital mortality: 67%). There was a significant equilateral correlation between creatine kinase (CK) and myoglobin at all measurement points. Furthermore, there was a significant reduction of myoglobin (p = 0.03, 95% confidence interval (CI): − 9030, − 908 ng/ml) during CS treatment, with a median relative reduction of 29%. A higher median reduction of 38% was seen in patients without ongoing rhabdomyolysis (CK decreased during CS treatment, n = 21). In contrast, myoglobin levels did not relevantly change in patients with increasing CK and therefore ongoing rhabdomyolysis (n = 22, median relative reduction 4%). Moreover, there was no significant difference in myoglobin elimination in patients with and without ECMO therapy. Conclusion Blood purification with Cytosorb® during high-flux dialysis led to a significant reduction of myoglobin in patients with severe rhabdomyolysis. The effect might be obscured by sustained rhabdomyolysis, which was seen in patients with rising CK during treatment. Prospective clinical trials would be useful in investigating its benefits in avoiding permanent kidney damage.

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Section: Introductionmentioning

confidence: 99%

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

et al. 2021

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“…[32][33][34][35][36] Unsurprisingly and consistently with the literature, RRT requirement and ICU LOS were higher in patients with intense RM. 4,37 Patients with intense RM had more transfusion requirements at 24 hours, which was possibly related to the higher severity of their trauma or to more severe coagulopathy. 17 Mortality in our cohort was consistent with the mortality typically seen in severe hemorrhagic trauma.…”

Section: Discussionmentioning

confidence: 99%

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

Martinez

Liaud-Laval

Laitselart

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Traumatic rhabdomyolysis (RM) is common and contributes to the development of medical complications, of which acute renal failure is the best described. Some authors have described an association between elevated aminotransferases and RM, suggesting the possibility of associated liver damage. Our study aims to evaluate the relationship between liver function and RM in hemorrhagic trauma patients. METHODS: This is a retrospective observational study conducted in a level 1 trauma center analyzing 272 severely injured patients transfused within 24 hours and admitted to intensive care unit (ICU) from January 2015 to June 2021. Patients with significant direct liver injury (abdominal Abbreviated Injury Score [AIS] >3) were excluded. Clinical and laboratory data were reviewed, and groups were stratified according to the presence of intense RM (creatine kinase [CK] >5000 U/L). Liver failure was defined by a prothrombin time (PT)-ratio <50% and an alanine transferase (ALT) >500 U/L simultaneously. Correlation analysis was performed using Pearson’s or Spearman’s coefficient depending on the distribution after log transformation to evaluate the association between serum CK and biological markers of hepatic function. Risk factors for the development of liver failure were defined with a stepwise logistic regression analysis of all relevant explanatory factors significantly associated with the bivariate analysis. RESULTS: RM (CK >1000 U/L) was highly prevalent in the global cohort (58.1%), and 55 (23.2%) patients presented with intense RM. We found a significant positive correlation between RM biomarkers (CK and myoglobin) and liver biomarkers (aspartate transferase [AST], ALT, and bilirubin). Log-CK was positively correlated with log-AST (r = 0.625, P < .001) and log-ALT (r = 0.507, P < .001) and minimally with log-bilirubin (r = 0.262, P < .001). Intensive care unit stays were longer for intense RM patients (7 [4–18] days vs 4 [2–11] days, P < .001). These patients required increased renal replacement therapy use (4.1% vs 20.0%, P < .001) and transfusion requirements. Liver failure was more common (4.6% vs 18.2%, P < .001) for intense RM patients. It was associated with bivariate and multivariable analysis with intense RM (odds ratio [OR], 4.51 [1.11–19.2]; P = .034), need for renal replacement therapy, and Sepsis-Related Organ Failure Assessment Score (SOFA) score on day 1. CONCLUSIONS: Our study established the presence of an association between trauma-related RM and classical hepatic biomarkers. Liver failure was associated with the presence of intense RM in bivariate and multivariable analysis. Traumatic RM could have a role in the development of other system failures, specifically at the hepatic level, in addition to the already known and well-described renal failure.

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“…The appearance of muscle pain, changes in sensitivity, muscle weakness, dark brown urine, myalgia, and edema of body segments are classic symptoms for RM (Torres et al, 2015, Efstratiadis et al, 2007. The main consequences of RM may be associated with acute renal failure, electrolytic disorder, cardiac arrhythmia, compartment syndrome, and eventually death (Sousa et al, 2013, Chen et al, 2013, Caldeira et al, 2001. The incidence of RM by physical exertion is approximately 30 for every 100,000 patients per year (Danielak et al, 2018, Eichner, 2020.…”

Section: Introductionmentioning

confidence: 99%

Urine proteomics as a non-invasive approach to monitor exertional rhabdomyolysis during military training

Carneiro

Macedo-da-Silva

Santiago

et al. 2022

Journal of Proteomics

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Rhabdomyolysis: risk factors and incidence in polytrauma patients in the absence of major disasters

Abstract: We found that a large number of factors are implicated in CK and Mb variations. Rhabdomyolysis is a very frequent complication, but increase in CK marker alone does not seem to be correlated with the incidence of ARF. Therefore, Mb level should be considered in this group of patients.

Cited by 12 publications

References 42 publications

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

Blood purification with a cytokine adsorber for the elimination of myoglobin in critically ill patients with severe rhabdomyolysis

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

Urine proteomics as a non-invasive approach to monitor exertional rhabdomyolysis during military training

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