Royal Children's Hospital, Parkville, Victoria, Australia.
Pediatric Intensive Care, Starship Children's Hospital, Auckland, New Zealand.
Pediatr Crit Care Med. 2018 Jan;19(1):e51-e57. doi: 10.1097/PCC.0000000000001397.
Rhabdomyolysis is a disorder of muscle breakdown. The aim of this study was to describe the epidemiology of rhabdomyolysis in children admitted to a PICU and to assess the relationship between peak creatinine kinase and mortality.
Retrospective cohort study in children admitted to the PICU with rhabdomyolysis between January 1, 2005, and December 31, 2014. Demographic, clinical, and outcome data were recorded. Outcomes were analyzed by level of peak creatinine kinase value (0-10,000, 10,001-50,000, > 50,000IU/L). Long-term renal outcomes were reported for PICU survivors.
A single-centre academic tertiary PICU.
Children admitted to the PICU with serum creatinine kinase level greater than 1,000 IU/L.
None.
There were 182 children with rhabdomyolysis. The median peak creatinine kinase value was 3,583 IU/L (1,554-9,608). The primary diagnostic categories included sepsis, trauma, and cardiac arrest. Mortality for peak creatinine kinase values 0-10,000, 10,001-50,000, and > 50,000 IU/L were 24/138 (17%), 6/28 (21%), and 3/16 (19%), respectively (p = 0.87). Children with a peak creatinine kinase greater than 10,000 IU/L had a longer duration of mechanical ventilation and ICU length of stay than children with peak creatinine kinase less than 10,000. Renal replacement therapy was administered in 29/182 (16%). There was longer duration of mechanical ventilation (273 [141-548] vs. 73 [17-206] hr [p < 0.001]) and ICU length of stay (334 [147-618] vs. 100 [37-232] hr (p < 0.001)] in children receiving renal replacement therapy. Continuous veno-venous hemofiltration was the most common modality 23/29 (79%). Only one child required renal replacement therapy postintensive care stay, and adverse long-term renal outcomes were uncommon.
In children with rhabdomyolysis requiring intensive care, peak creatinine kinase was not associated with mortality but is associated with greater use of intensive care resources. Chronic kidney disease is an uncommon sequelae of rhabdomyolysis in children requiring intensive care.
横纹肌溶解症是一种肌肉分解的疾病。本研究的目的是描述儿童重症监护病房（PICU）收治的横纹肌溶解症患者的流行病学，并评估肌酸激酶峰值与死亡率之间的关系。
2005 年 1 月 1 日至 2014 年 12 月 31 日期间，对在 PICU 收治的横纹肌溶解症患儿进行回顾性队列研究。记录了人口统计学、临床和结局数据。根据肌酸激酶峰值水平（0-10000、10001-50000、>50000IU/L）对结局进行分析。报告了 PICU 幸存者的长期肾脏结局。
单中心学术性三级 PICU。
血清肌酸激酶水平>1000IU/L 并收入 PICU 的患儿。
无。
共纳入 182 例横纹肌溶解症患儿。肌酸激酶峰值中位数为 3583IU/L（1554-9608）。主要诊断类别包括脓毒症、创伤和心搏骤停。肌酸激酶峰值 0-10000、10001-50000 和>50000IU/L 的死亡率分别为 24/138（17%）、6/28（21%）和 3/16（19%）（p=0.87）。肌酸激酶峰值>10000IU/L 的患儿机械通气时间和 ICU 住院时间长于肌酸激酶峰值<10000IU/L 的患儿。182 例患儿中，29 例（16%）接受了肾脏替代治疗。接受肾脏替代治疗的患儿机械通气时间（273[141-548]vs.73[17-206]hr[p<0.001]）和 ICU 住院时间（334[147-618]vs.100[37-232]hr[p<0.001]）均更长。连续性静脉-静脉血液滤过是最常见的治疗方式（23/29，79%）。仅有 1 例患儿在重症监护后需要肾脏替代治疗，长期肾脏不良结局并不常见。
在需要重症监护的横纹肌溶解症患儿中，肌酸激酶峰值与死亡率无关，但与更多地使用重症监护资源相关。慢性肾脏病是需要重症监护的横纹肌溶解症患儿的一种罕见后遗症。
