Saverymuthu Alvin, Teo Rufinah, Zain Jaafar Md, Cheah Saw Kian, Yusof Aliza Mohamad, Rahman Raha Abdul
Department of Anaesthesiology & Intensive Care, Hospital Canselor Tuanku Muhriz, University Kebangsaan Malaysia (UKM), Kuala Lumpur, Malaysia.
J Crit Care Med (Targu Mures). 2021 Nov 6;7(4):267-271. doi: 10.2478/jccm-2021-0025. eCollection 2021 Oct.
Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury.
To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients.
All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury.
Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001].
One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.
横纹肌溶解症是由受损骨骼肌的快速分解引起的，可能导致急性肾损伤。
确定重症患者横纹肌溶解症后肾损伤的发生率及相关风险。
对2016年1月至2017年12月收治的所有重症患者进行筛查。肌酸激酶水平高于正常上限5倍（>1000 U/L）被定义为横纹肌溶解症，肾损伤根据改善全球肾脏病预后组织（KDIGO）评分来确定。此外，将创伤、长时间手术、脓毒症、抗精神病药物、高热列为肾损伤的危险因素。
在1620例入院患者中，149例（9.2%）被确定为患有横纹肌溶解症，54例（36.2%）发生了肾损伤。大体而言，急性肾损伤与横纹肌溶解症、长时间手术（18.7%）、脓毒症（50.0%）或创伤（31.5%）有关。与肾损伤组（Z=-0.623，p=0.534）相比，非肾损伤组水化治疗后肌酸激酶水平的降低具有统计学意义（Z=-3.948，p<0.05）。值得注意的是，平均体重>50kg发生急性肾损伤的几率为1.040（p<0.001），序贯器官衰竭评估（SOFA）评分>2时为1.372（p<0.001），脓毒症时为5.333（p<0.001）；多因素回归分析显示，SOFA评分>2（p<0.001）体重>50kg（p=0.016）和脓毒症（p<0.05）是独立危险因素。横纹肌溶解症导致的总体死亡率为15.4%（23/149），肾损伤组的死亡率（35.2%）显著高于非肾损伤组（3.5%）[p<0.001]。
三分之一的横纹肌溶解症患者发生了急性肾损伤，死亡率显著较高。脓毒症是急性肾损伤的主要原因。脓毒症和SOFA评分>2均为显著的独立危险因素。
