Department of Critical Care Medicine and Hospital Infection Prevention and Control, Shenzhen Second People's Hospital and First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China.
Shantou University Medical College, Shantou, China.
Int J Hyperthermia. 2022;39(1):446-454. doi: 10.1080/02656736.2022.2046183.
OBJECTIVE: Rhabdomyolysis (RM) in exertional heatstroke (EHS) often leads to multiple organ dysfunction including acute kidney injury (AKI). Studies have shown that serum creatine kinase (CK) >1000 U/L as a serological diagnostic criterion for RM does not reflect the risk of AKI or mortality. METHODS: This longitudinal cohort study included all patients with EHS who were admitted to intensive care unit between January 2008 and June 2019. Serum myoglobin (sMb) was studied as the serological marker of RM and compared with CK. Outcome events were AKI and 90-day mortality. RESULTS: A total of 161 patients were enrolled, of whom 52 (32.3%) had sMb ≥1000 ng/mL. Patients with sMb ≥1000 ng/mL had higher SOFA score, higher APACHE II score, lower GCS score, and higher incidence of disseminated intravascular coagulation, acute myocardial injury, acute liver injury, AKI, and 90-day mortality than patients with sMb <1000 ng/mL. Lymphocytes, neutrophils, D-Dimer were risk factors for AKI in patients with sMb ≥1000 ng/mL. Curve fitting showed a curved relationship between sMb and EHS-induced AKI but not CK. sMb ≥1000 ng/mL showed better predictive ability for AKI (area under curve: 0.786). APACHE II, SOFA, and GCS scores were risk factors for 90-day mortality in patients with sMb ≥1000 ng/mL. CONCLUSION: Serum myoglobin is a better predictor of AKI and 90-day mortality than CK in patients with RM after EHS.
目的：运动性热射病（EHS）中的横纹肌溶解症（RM）常导致多器官功能障碍，包括急性肾损伤（AKI）。研究表明，血清肌酸激酶（CK）＞1000 U/L 作为 RM 的血清学诊断标准并不能反映 AKI 或死亡率的风险。
方法：这项纵向队列研究纳入了 2008 年 1 月至 2019 年 6 月期间入住重症监护病房的所有 EHS 患者。研究了血清肌红蛋白（sMb）作为 RM 的血清学标志物，并与 CK 进行了比较。结局事件为 AKI 和 90 天死亡率。
结果：共纳入 161 例患者，其中 52 例（32.3%）sMb≥1000ng/mL。sMb≥1000ng/mL 的患者 SOFA 评分更高，APACHE II 评分更高，GCS 评分更低，弥散性血管内凝血、急性心肌损伤、急性肝损伤、AKI 和 90 天死亡率的发生率更高。淋巴细胞、中性粒细胞、D-二聚体是 sMb≥1000ng/mL 患者 AKI 的危险因素。曲线拟合显示 sMb 与 EHS 引起的 AKI 之间呈曲线关系，但与 CK 无关。sMb≥1000ng/mL 对 AKI 的预测能力更好（曲线下面积：0.786）。APACHE II、SOFA 和 GCS 评分是 sMb≥1000ng/mL 患者 90 天死亡率的危险因素。
结论：在 RM 后 EHS 患者中，血清肌红蛋白是预测 AKI 和 90 天死亡率的比 CK 更好的指标。
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