Lim Andy K H, Azraai Meor, Pham Jeanette H, Looi Wenye F, Bennett Caitriona
Department of General Medicine, Monash Health, Clayton, VIC, Australia.
Department of Nephrology, Monash Health, Clayton, VIC, Australia.
Front Med (Lausanne). 2020 Nov 9;7:588114. doi: 10.3389/fmed.2020.588114. eCollection 2020.
Acute kidney injury is a known complication of severe rhabdomyolysis. In patients who present to hospital with rhabdomyolysis, illicit drug use is associated with a higher risk of acute kidney injury needing renal replacement therapy (RRT), independent of the peak serum creatine kinase level. The aim of this study was to assess if RRT duration and renal outcomes were also worse in illicit drug use-associated rhabdomyolysis. We conducted a cohort study of adult patients who presented to Monash Health (Jan 2011-June 2020) with rhabdomyolysis and required RRT. Patients with isolated myocardial injury and cardiac arrest were excluded. We used survival analysis to examine the time to RRT independence, utilizing the Fine-Gray competing risks regression and death as the competing event. A subdistribution hazard ratio (SHR) < 1.0 represents a relatively greater duration of RRT and a worse outcome. We included 101 patients with a mean age of 58 years, of which 17% were cases associated with illicit drug use. The median peak creatine kinase level was 5,473 U/L (interquartile range, 1,795-17,051 U/L). Most patients (79%) initiated RRT within 72 h of admission, at a median serum creatinine of 537 μmol/L (interquartile range, 332-749 μmol/L). In the competing risks analysis, the estimated SHR was 1.48 (95% CI: 0.78-2.84, = 0.23) for illicit drug use, 0.87 (95% CI: 0.76-0.99, = 0.041) for the log-transformed peak creatine kinase, and 0.41 (95% CI: 0.25-0.67, < 0.001) for sepsis. A 50% cumulative incidence of RRT independence occurred at 11 days (95% CI: 8-16 days). Only 5% of patients remained on RRT at 3 months. In rhabdomyolysis-associated acute kidney injury, it is unlikely that patients with illicit drug use-associated rhabdomyolysis require a longer duration of RRT compared to patients with rhabdomyolysis from other causes.
急性肾损伤是严重横纹肌溶解症的一种已知并发症。在因横纹肌溶解症入院的患者中，非法药物使用与需要肾脏替代治疗（RRT）的急性肾损伤风险较高相关，且独立于血清肌酸激酶峰值水平。本研究的目的是评估在与非法药物使用相关的横纹肌溶解症中，RRT持续时间和肾脏结局是否也更差。我们对2011年1月至2020年6月在莫纳什医疗中心因横纹肌溶解症就诊并需要RRT的成年患者进行了一项队列研究。排除了单纯心肌损伤和心脏骤停的患者。我们使用生存分析来检查RRT独立时间，采用Fine-Gray竞争风险回归并将死亡作为竞争事件。亚分布风险比（SHR）<1.0表示RRT持续时间相对更长且结局更差。我们纳入了101例平均年龄为58岁的患者，其中17%为与非法药物使用相关的病例。肌酸激酶峰值中位数为5473 U/L（四分位间距，1795 - 17051 U/L）。大多数患者（79%）在入院72小时内开始RRT治疗，血清肌酐中位数为537 μmol/L（四分位间距，332 - 749 μmol/L）。在竞争风险分析中，非法药物使用的估计SHR为1.48（95%CI：0.78 - 2.84，P = 0.23），对数转换后的肌酸激酶峰值为0.87（95%CI：0.76 - 0.99，P = 0.041），脓毒症为0.41（95%CI：0.25 - 0.67，P < 0.001）。RRT独立的累积发生率在11天达到50%（95%CI：8 - 16天）。3个月时仅有5%的患者仍在接受RRT治疗。在横纹肌溶解症相关的急性肾损伤中，与其他原因导致横纹肌溶解症的患者相比，与非法药物使用相关的横纹肌溶解症患者不太可能需要更长时间的RRT治疗。
