Risk factors for severe acute kidney injury among patients with rhabdomyolysis

Abstract

Background Acute kidney injury (AKI) is a life-threatening complication of rhabdomyolysis (RM). The aim of the present study was to assess patients at high risk for the occurrence of severe AKI defined as stage II or III of KDIGO classification and in-hospital mortality of AKI following RM. Methods We performed a retrospective study of patients with creatine kinase levels > 1000 U/L, who were admitted to the West China Hospital of Sichuan University between January 2011 and March 2019. The sociodemographic, clinical and laboratory data of these patients were obtained from an electronic medical records database, and univariate and multivariate regression analyses were subsequently conducted. Results For the 329 patients included in our study, the incidence of AKI was 61.4% and the proportion of stage I, stage II, stage III were 18.8, 14.9 and 66.3%, respectively. The overall mortality rate was 19.8%; furthermore, patients with AKI tended to have higher mortality rates than those without AKI (24.8% vs. 11.8%; P < 0.01). The clinical conditions most frequently associated with RM were trauma (28.3%), sepsis (14.6%), bee sting (12.8%), thoracic and abdominal surgery (11.2%) and exercise (7.0%). Furthermore, patients with RM resulting from sepsis, bee sting and acute alcoholism were more susceptible to severe AKI. The risk factors for the occurrence of stage II-III AKI among RM patients included hypertension (OR = 2.702), high levels of white blood cell count (OR = 1.054), increased triglycerides (OR = 1.260), low level of high-density lipoprotein cholesterol (OR = 0.318), elevated serum phosphorus (OR = 5.727), 5000<CK ≤ 10,000 U/L (OR = 2.617) and CK>10,000 U/L (OR = 8.093). Age ≥ 60 years (OR = 2.946), sepsis (OR = 3.206) and elevated prothrombin time (OR = 1.079) were independent risk factors for in-hospital mortality in RM patients with AKI. Conclusions AKI is independently associated with mortality in patients with RM, and several risk factors were found to be associated with the occurrence of severe AKI and in-hospital mortality. These findings suggest that, to improve the quality of medical care, the early prevention of AKI should focus on high-risk patients and more effective management.

Cystatin C: A Potential Predictor for Acute Kidney Injury in Patients With Community Acquired Pneumonia

“…A recent report showed that serum uric acid was an independent predictor of AKI in patients with COVID-19 [32]. Platelet count and white blood cell count were two biomarkers for AKI, and low level of platelet count and high level of white blood cell count could increase risk of AKI [33][34][35][36] which was consistent with our ndings.…”

Earlier CRRT is Associated with Reduced Mortality in Rhabdomyolysis Patients

“…RM is a common severe clinical presentation with complicated etiologies. The causes of RM were different among various studies [4,8,20]. In our present cohort, the common causes were trauma, heat stroke, and vascular ischemia.…”

“…Acute kidney injury (AKI) is the most common and severe complication of RM, occurred in 20%-60% of patients with RM. And, for RM related AKI patients, the mortality rate was signi cantly increased and was reported to be as high as 60% [3,4]. The elevated circulation myoglobin, which could accelerate kidney injury by promoting vasoconstriction, blocking renal tubules, causing oxidative stress lipid peroxidation, and inducing in ammation, is considered to be the most important pathogenesis of RM related AKI [5][6][7].…”

“…However, rehydration was limited in the RM patient who had AKI and electrolyte disturbances. Continuous renal replacement therapy (CRRT) is used as an important intervention in 8%-41% of patients with severe rhabdomyolysis [4,8]. It was reported that CRRT was effective on the clearance of serum myoglobin, correction of electrolyte disturbance, removal of in ammatory mediators, and stabilization of the internal environment [9][10][11].…”

Liberal Intravenous Fluid Administration in a Rare Case of Severe Rhabdomyolysis Secondary to SARS-CoV-2

“…Certain risk factors are associated with increased mortality rate, including patients with hypertension, low levels of high-level data link control (HDLC), elevated white blood cells, age >60 years, hypertriglyceridemia, and hyperphosphatemia [13]. The recommended rate of crystalloid fluid initiation is at a rate of 1.5L per hour to maintain an adequate urine output of approximately 200-300 cc per hour [2].…”