Baeza-Trinidad R, Brea-Hernando A, Morera-Rodriguez S, Brito-Diaz Y, Sanchez-Hernandez S, El Bikri L, Ramalle-Gomara E, Garcia-Alvarez J L
Internal Medicine Department, Hospital San Pedro, Logroño, Spain.
Department of Epidemiology, La Rioja Regional Authority, Logroño, Spain.
Intern Med J. 2015 Nov;45(11):1173-8. doi: 10.1111/imj.12815.
Rhabdomyolysis (RB) is a syndrome characterised by decomposition of skeletal muscle that could be life threatening, so the identification of biomarkers of its severity could help us in its treatment. Creatine kinase (CK) is usually taken as a reference in patients with RB in order to stratify prognosis, however that is not probably the most effective parameter.
The present study was designed to analyse the specific features and mortality of patients with RB and the relation between creatinine, CK and mortality.
Retrospective cohort analysis among patients admitted to San Pedro Hospital in Logroño (Spain) with RB (CK levels higher than 2000 U/L) diagnosed since 1 January 2009 until 31 December 2; 013 522 patients with RB patients diagnosed of RB were collected. The aetiology and the analytical feature (creatinine, CK, calcium, phosphorus, pH and bicarbonate), as well as 30-year mortality, were investigated.
Among the 522 patients, there were 138 deaths. Four patients required renal replacement therapy. The most common cause of RB was trauma (29%). Infectious aetiology had the highest mortality (41.2%). The median CK was 3451 u/L (interquartile range 3348), and the mean creatinine at admission was 132.6 umol/L (±110.5). Initial CK levels do not have predictive ability on mortality or renal dysfunction in contrast to initial creatinine values. Each state of acute kidney injury (AKI) increased mortality compared with those who have not presented this renal dysfunction (P < 0.0001). Age, calcium, phosphorus, bicarbonate and pH are associated with AKI.
Despite being a diagnostic marker for RB, initial CK levels do not predict mortality. However, creatinine initial levels are related to progression to acute renal injury and mortality at 30 days.
横纹肌溶解症（RB）是一种以骨骼肌分解为特征的综合征，可能危及生命，因此识别其严重程度的生物标志物有助于治疗。肌酸激酶（CK）通常被用作RB患者预后分层的参考指标，然而这可能不是最有效的参数。
本研究旨在分析RB患者的具体特征和死亡率，以及肌酐、CK与死亡率之间的关系。
对2009年1月1日至2013年12月31日在西班牙洛格罗尼奥圣佩德罗医院确诊为RB（CK水平高于2000 U/L）的患者进行回顾性队列分析，共收集了522例RB患者。调查了病因、分析特征（肌酐、CK、钙、磷、pH值和碳酸氢盐）以及30年死亡率。
522例患者中，有138例死亡。4例患者需要肾脏替代治疗。RB最常见的病因是创伤（29%）。感染性病因的死亡率最高（41.2%）。CK中位数为3451 u/L（四分位间距为3348），入院时肌酐平均水平为132.6 μmol/L（±110.5）。与初始肌酐值相比，初始CK水平对死亡率或肾功能不全没有预测能力。与未出现这种肾功能障碍的患者相比，急性肾损伤（AKI）的每种状态都会增加死亡率（P<0.0001）。年龄、钙、磷、碳酸氢盐和pH值与AKI相关。
尽管CK是RB的诊断标志物，但初始CK水平不能预测死亡率。然而，肌酐初始水平与急性肾损伤的进展和30天死亡率相关。
