Raju Nithin Abraham, Rao Shoma Vinay, Joel J Chakravarthy, Jacob Gijoe George, Anil Arun Kunnanchery, Gowri S Mahasampath, Kandasamy Subramani
Division of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Anaesthesia, Bangalore Baptist Hospital, Bengaluru, Karnataka, India.
Indian J Crit Care Med. 2017 Dec;21(12):852-856. doi: 10.4103/ijccm.IJCCM_186_17.
Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM.
A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with "crush protocol." Daily/twice a day, serum CPK and myoglobin were estimated. Categorical data are expressed as frequency and percentage, and the continuous variables are presented as mean (standard deviation) or median (interquartile range) based on normality. Other statistical analyses were done using the Chi-square test, independent -test, and rank sum test based on normality.
Fourteen out of 90 patients developed AKI and one patient required renal replacement therapy. CPK value of >12,000 U/l was identified to have 64% sensitivity and 56% specificity for developing AKI whereas serum myoglobin value of >5000 ng/ml was identified to have 78% sensitivity and 77% specificity for developing AKI.
Following traumatic RM, in patients on "crush protocol," serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI.
横纹肌溶解症（RM）是一种横纹肌纤维受损，导致肌红蛋白、肌酸磷酸激酶（CPK）及其他细胞内成分释放入血液循环的病症。高肌红蛋白水平会导致急性肾损伤（AKI）。创伤是RM最常见的病因，并发症的发生与肌红蛋白释放程度相关。目前，RM的严重程度通过血清CPK进行评估并据此开展治疗。由于肌红蛋白是AKI的直接病因，我们旨在确定血清肌红蛋白在创伤性RM导致AKI方面是否比CPK是更可靠的预测指标。
对一家三级医院外科重症监护病房/高依赖病房收治的90例血清CPK>5000 U/L的创伤性RM患者进行前瞻性观察研究。除了包括血管内容量优化和血流动力学稳定在内的标准治疗外，他们还接受了“挤压方案”治疗。每天/每天两次，测定血清CPK和肌红蛋白。分类数据以频率和百分比表示，连续变量根据正态性以均值（标准差）或中位数（四分位间距）表示。其他统计分析根据正态性使用卡方检验、独立检验和秩和检验进行。
90例患者中有14例发生AKI，1例患者需要肾脏替代治疗。CPK值>12,000 U/l对发生AKI的敏感性为64%，特异性为56%，而血清肌红蛋白值>5000 ng/ml对发生AKI的敏感性为78%，特异性为77%。
创伤性RM后，对于接受“挤压方案”治疗的患者，血清肌红蛋白在预测AKI方面比血清CPK是更敏感、更具特异性的检测指标。
