Waldman Wojciech, Kabata Piotr M, Dines Alison M, Wood David M, Yates Christopher, Heyerdahl Fridtjof, Hovda Knut Erik, Giraudon Isabelle, Dargan Paul I, Sein Anand Jacek
Department of Clinical Toxicology, Medical University of Gdansk, Gdansk, Poland.
Pomeranian Centre of Toxicology, Gdansk, Poland.
PLoS One. 2021 Mar 11;16(3):e0246297. doi: 10.1371/journal.pone.0246297. eCollection 2021.
This study was conducted to retrospectively assess the relationships between: rhabdomyolysis (quantified by creatine kinase (CK) activity) and kidney injury (quantified by serum creatinine concentration), sex, age, body temperature on admission, presence of seizures, and agitation or aggression in patients presenting to the Emergency Department with acute recreational drug toxicity. We also investigated the association with the substances ingested.
All presentations to the 16 sentinel Euro-DEN centres in 10 European countries with acute recreational drug toxicity during the first year of the Euro-DEN study (October 2013 to September 2014) were considered. Cases that had abnormal CK activity recorded as part of routine clinical care were divided into 3 cohorts depending on peak CK activity. Cases with normal CK activity were included as a control group (4th cohort).
Only 1,015 (18.4%) of the 5,529 Euro-DEN presentations had CK activity concentration recorded. Of this group 353 (34.8%) had also creatinine concentration measured. There were 375 (36.9%) with minor rhabdomyolysis, 69 (6.8%) with moderate rhabdomyolysis, and 24 (2.4%) with severe rhabdomyolysis; 547 (53.9%) were included in the control group. There was a positive correlation between CK activity and creatinine concentration (correlation coefficient r = 0.71, p<0.0001). There was no correlation between CK activity and body temperature at the time of presentation to the ED (correlation coefficient r = 0.07, p = 0.03). There was a positive correlation between CK activity and length of stay in the hospital (r = 0.31, p<0.001). There was no association between CK activity and the presence of seizures (p = 0.33) or agitation/aggression (p = 0.45), patients age (p = 0.4) or sex (p = 0.25). The 5 most common agents amongst patients presenting with rhabdomyolysis were: cocaine (n = 107; 22.9% presentations), amphetamine (76; 16.2%), cannabis (74; 15.8%), GHB/GBL (72; 15.4%) and heroin (67; 14.3%). The distribution of rhabdomyolysis in 5 most common drugs was (drug; patients with rhabdomyolysis, patients without rhabdomyolysis): cocaine (107, 122), cannabis (74, 117), GHB/GBL (72, 81), amphetamine (76, 66), heroin (67, 70).
Abnormal values of CK activity occurred in almost half (46.1%) of presentations to the Emergency Department with acute recreational drug toxicity in whom CK activity was measured; however, severe rhabdomyolysis is seen in only a small minority (2.4%). Those with rhabdomyolysis are at significantly higher risk of kidney injury and have a longer length of hospital stay.
本研究旨在回顾性评估急诊科收治的急性娱乐性药物中毒患者中，横纹肌溶解（通过肌酸激酶（CK）活性量化）与肾损伤（通过血清肌酐浓度量化）、性别、年龄、入院时体温、癫痫发作情况以及激越或攻击行为之间的关系。我们还研究了与所摄入物质的关联。
纳入欧洲药物不良反应监测网络（Euro-DEN）研究第一年（2013年10月至2014年9月）期间，10个欧洲国家16个哨点中心所有急性娱乐性药物中毒的就诊病例。将作为常规临床护理一部分记录的CK活性异常的病例根据CK峰值活性分为3组。CK活性正常的病例作为对照组（第4组）。
在Euro-DEN研究的5529例就诊病例中，仅1015例（18.4%）记录了CK活性浓度。该组中353例（34.8%）还测量了肌酐浓度。轻度横纹肌溶解375例（36.9%），中度横纹肌溶解69例（6.8%），重度横纹肌溶解24例（2.4%）；547例（53.9%）纳入对照组。CK活性与肌酐浓度呈正相关（相关系数r = 0.71，p<0.0001）。就诊于急诊科时CK活性与体温无相关性（相关系数r = 0.07，p = 0.03）。CK活性与住院时间呈正相关（r = 0.31，p<0.001）。CK活性与癫痫发作（p = 0.33）、激越/攻击行为（p = 0.45）、患者年龄（p = 0.4）或性别（p = 0.25）均无关联。横纹肌溶解患者中最常见的5种药物为：可卡因（n = 107；占就诊病例的22.9%）、苯丙胺（76例；16.2%）、大麻（74例；15.8%）、γ-羟基丁酸/γ-丁内酯（GHB/GBL，72例；15.4%）和海洛因（67例；14.3%）。5种最常见药物所致横纹肌溶解的分布情况为（药物；发生横纹肌溶解的患者数，未发生横纹肌溶解的患者数）：可卡因（107例，122例）、大麻（74例，117例）、GHB/GBL（72例，81例）、苯丙胺（76例，66例）、海洛因（67例，70例）。
在测量CK活性的急性娱乐性药物中毒急诊科就诊病例中，近半数（46.1%）出现CK活性异常值；然而，重度横纹肌溶解仅占少数（2.4%）。发生横纹肌溶解的患者肾损伤风险显著更高，住院时间更长。
