Simpson Joanna P, Taylor Andrew, Sudhan Nazneen, Menon David K, Lavinio Andrea
From the Neurosciences and Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UK.
Eur J Anaesthesiol. 2016 Dec;33(12):906-912. doi: 10.1097/EJA.0000000000000490.
High-volume fluid resuscitation and the administration of sodium bicarbonate and diuretics have a theoretical renoprotective role in patients at high risk of acute kidney injury (AKI) following rhabdomyolysis. Abnormally elevated creatine kinase has previously been used as a biological marker for the identification of patients at high risk of AKI following rhabdomyolysis.
To assess the sensitivity and specificity of plasma creatine kinase (admission and peak values) for the prediction of AKI requiring renal replacement therapy (RRT) or of death in patients with confirmed rhabdomyolysis. To compare the diagnostic performance of creatine kinase with the McMahon score.
Retrospective observational study. Data collection included McMahon and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores; daily creatine kinase; daily creatinine and electrolytes; ICU length of stay and mortality.
Neurosciences and Trauma Critical Care Unit (Cambridge, UK).
In total, 232 adults with confirmed rhabdomyolysis (creatine kinase > 1000 Ul) admitted to Neurosciences and Trauma Critical Care Unit between 2002 and 2012.
AKI, RRT and mortality.
Forty-five (19%) patients developed AKI and 29 (12.5%) patients required RRT. Mortality was significantly higher in patients who developed AKI (62 vs. 18%, P < 0.001). Average creatine kinase on admission was 5009 (range 69-157 860) Ul. Creatine kinase peaked between the day of admission and day 3 in 91% of cases. PEAK creatine kinase of at least 5000 Ul is 55% specific and 83% sensitive for the prediction of AKI requiring RRT. A McMahon Score of at least 6 calculated on admission is 68% specific and 86% sensitive for RRT.
Creatine kinase is not a specific or early predictor of AKI in patients with rhabdomyolysis. Although a PEAK creatine kinase of at least 5000 Ul has sensitivity acceptable for screening purposes, this is often a delayed finding. A McMahon score of at least 6 calculated on admission allows for a more sensitive, specific and timely identification of patients who may benefit from high-volume fluid resuscitation.
大量液体复苏以及碳酸氢钠和利尿剂的使用，对于横纹肌溶解后急性肾损伤（AKI）高风险患者具有理论上的肾脏保护作用。异常升高的肌酸激酶此前一直被用作识别横纹肌溶解后AKI高风险患者的生物学标志物。
评估血浆肌酸激酶（入院时及峰值）对确诊横纹肌溶解患者中需要肾脏替代治疗（RRT）的AKI或死亡的预测敏感性和特异性。比较肌酸激酶与麦克马洪评分的诊断性能。
回顾性观察研究。数据收集包括麦克马洪评分和急性生理与慢性健康状况评估II（APACHE II）评分；每日肌酸激酶；每日肌酐和电解质；重症监护病房住院时间和死亡率。
神经科学与创伤重症监护病房（英国剑桥）。
2002年至2012年期间，共有232名确诊横纹肌溶解（肌酸激酶>1000 U/L）的成年人入住神经科学与创伤重症监护病房。
AKI、RRT和死亡率。
45名（19%）患者发生AKI，29名（12.5%）患者需要RRT。发生AKI的患者死亡率显著更高（62%对18%，P<0.001）。入院时平均肌酸激酶为5009（范围69 - 157860）U/L。91%的病例中肌酸激酶在入院当天至第3天达到峰值。峰值肌酸激酶至少为5000 U/L对预测需要RRT的AKI的特异性为55%，敏感性为83%。入院时计算的麦克马洪评分至少为6对RRT的特异性为68%，敏感性为86%。
肌酸激酶并非横纹肌溶解患者AKI的特异性或早期预测指标。虽然峰值肌酸激酶至少为5000 U/L对于筛查目的而言敏感性尚可，但这往往是一个延迟发现。入院时计算的麦克马洪评分至少为6能够更敏感、特异且及时地识别可能从大量液体复苏中获益的患者。
