静脉碳酸氢盐和肌酸激酶在急性创伤性横纹肌溶解症中的诊断和预后工具。

Venous bicarbonate and creatine kinase as diagnostic and prognostic tools in the setting of acute traumatic rhabdomyolysis.

机构信息

Department of Surgery, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Surgery, Khayelitsha District Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

出版信息

S Afr Med J. 2021 Mar 31;111(4):333-337. doi: 10.7196/SAMJ.2021.v111i4.14915.

DOI:10.7196/SAMJ.2021.v111i4.14915

PMID:33944766

Abstract

BACKGROUND

Myorenal or crush syndrome often develops following soft-tissue traumatic injury. It is a spectrum of disease that may result in severe renal dysfunction and kidney injury requiring renal replacement therapy.

OBJECTIVES

To review a large cohort of patients with so-called myorenal or crush syndrome and assess the biochemical markers of venous bicarbonate and creatine kinase as predictors for the development of acute kidney injury (AKI).

METHODS

All patients with myorenal syndrome who presented to Khayelitsha District Hospital, Cape Town, South Africa (SA), and Ngwelezana Hospital, Empangeni, KwaZulu-Natal, SA, between January and December 2017 were identified and reviewed.

RESULTS

A total of 212 patients were included in the study. At both hospitals, 94% of the patients were male. Using the Pearson correlation coefficient, we compared creatinine kinase (CK) against serum creatinine. The mean CK level was 5 311.8 U/L and the mean creatinine level 133.457 μmol/L. The r-value was 0.2533. Although this is a technically positive correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000208. When comparing venous bicarbonate (HCO3) against creatinine, the mean HCO3 level was 22.296 mmol/L and the mean creatinine level 162.053 μmol/L. The r-value was -0.3468. Although this is a technically negative correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000013. The inverse ratio shown with HCO3 v. creatinine, although still a weak correlation, is significantly better in predicting an increase in creatinine compared with the weak positive correlation of CK v. creatinine.

CONCLUSIONS

Although both venous HCO3 and CK showed a weak correlation with creatinine, the former performed significantly better in predicting AKI. In a resource-constrained system, we recommend that HCO3 be measured to assess patients with crush injury and that CK be regarded as a complementary modality.

摘要

背景

肌肾或挤压综合征常继发于软组织创伤性损伤。它是一种疾病谱，可能导致严重的肾功能障碍和需要肾脏替代治疗的肾损伤。

目的

回顾一大群所谓的肌肾或挤压综合征患者，并评估静脉碳酸氢盐和肌酸激酶的生化标志物作为急性肾损伤 (AKI) 发展的预测因子。

方法

在南非开普敦的 Khayelitsha 区医院和夸祖鲁-纳塔尔省恩格韦莱扎纳的 Ngwelezana 医院，对 2017 年 1 月至 12 月间就诊的所有肌肾综合征患者进行识别和回顾。

结果

共有 212 名患者纳入研究。在两家医院，94%的患者为男性。使用 Pearson 相关系数比较肌酸激酶（CK）与血清肌酐。平均 CK 水平为 5311.8 U/L，肌酐水平为 133.457 μmol/L。r 值为 0.2533。虽然这是一个技术上的正相关，但变量之间的关系很弱。使用 Pearson R 计算器，我们插入 r 值计算 p 值。p 值为 0.000208。比较静脉碳酸氢盐（HCO3）与肌酐时，平均 HCO3 水平为 22.296 mmol/L，肌酐水平为 162.053 μmol/L。r 值为-0.3468。虽然这是一个技术上的负相关，但变量之间的关系很弱。使用 Pearson R 计算器，我们插入 r 值计算 p 值。p 值为 0.000013。HCO3 与肌酐的倒数关系，尽管仍然是一个弱相关，但在预测肌酐升高方面明显优于 CK 与肌酐的弱正相关。