Department of Gastroenterology, 923rd Hospital of PLA Joint Logistics Support Force, Nanning, China.
Department of Infectious Disease, Huoshenshan Hospital, Wuhan, China.
Shock. 2021 Sep 1;56(3):360-367. doi: 10.1097/SHK.0000000000001725.
Rhabdomyolysis (RM) has been associated with many viral infectious diseases, and associated with poor outcomes. We aim to evaluate the clinical features and outcomes of RM in patients with coronavirus disease 2019 (COVID-19).
This was a single-center, retrospective, cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan Hospital in Wuhan, China, between February 17 and April 12, 2020.
The overall incidence of RM was 2.2%. Compared with patients without RM, those with RM tended to have a higher risk of deterioration. Patients with RM also constituted a greater percentage of patients admitted to the intensive care unit (90.9% vs. 5.3%, P < 0.001) and a greater percentage of patients undergoing mechanical ventilation (86.4% vs. 2.7% P < 0.001). Moreover, patients with RM had laboratory test abnormalities, including the presence of markers of inflammation, activation of coagulation, and kidney injury. Patients with RM also had a higher risk of in-hospital death (P < 0.001). Cox's proportional hazard regression model analysis confirmed that RM indicators, including peak creatine kinase levels > 1,000 IU/L (HR = 6.46, 95% CI: 3.02-13.86) and peak serum myoglobin concentrations > 1,000 ng/mL (HR = 9.85, 95% CI: 5.04-19.28), were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have delayed viral clearance.
RM might be an important contributing factor to adverse outcomes in COVID-19 patients. The early detection and effective intervention of RM may help reduce mortality among COVID-19 patients.
横纹肌溶解症（RM）与许多病毒性传染病有关，并与不良预后相关。本研究旨在评估 2019 年冠状病毒病（COVID-19）患者中 RM 的临床特征和结局。
这是一项在中国武汉火神山医院对 2020 年 2 月 17 日至 4 月 12 日期间连续收治的 1014 例确诊 COVID-19 住院患者进行的单中心、回顾性、队列研究。
RM 的总体发生率为 2.2%。与无 RM 的患者相比，RM 患者病情恶化的风险更高。RM 患者入住重症监护病房的比例也更高（90.9% vs. 5.3%，P<0.001），机械通气的比例也更高（86.4% vs. 2.7%，P<0.001）。此外，RM 患者实验室检查异常，包括炎症标志物、凝血激活和肾损伤。RM 患者住院期间死亡风险也更高（P<0.001）。Cox 比例风险回归模型分析证实，RM 指标，包括峰值肌酸激酶水平>1000IU/L（HR=6.46，95%CI：3.02-13.86）和峰值血清肌红蛋白浓度>1000ng/mL（HR=9.85，95%CI：5.04-19.28），是住院死亡的独立危险因素。此外，发生 RM 的 COVID-19 患者病毒清除时间往往延迟。
RM 可能是 COVID-19 患者不良结局的一个重要因素。早期发现和有效干预 RM 可能有助于降低 COVID-19 患者的死亡率。
