Department of Anesthesiology, LMU hospital, Munich, Germany.
Institute of Laboratory Medicine, LMU hospital, Munich, Germany.
Ren Fail. 2023;45(2):2259231. doi: 10.1080/0886022X.2023.2259231. Epub 2023 Sep 20.
Severe rhabdomyolysis frequently results in acute kidney injury (AKI) due to myoglobin accumulation with the need of kidney replacement therapy (KRT). The present study investigated whether the application of Cytosorb® (CS) led to an increased rate of kidney recovery in patients with KRT due to severe rhabdomyolysis. Adult patients with a myoglobin-concentration >10,000 ng/ml and KRT were included from 2014 to 2021. Exclusion criteria were chronic kidney disease and CS-treatment before study inclusion. Groups 1 and 2 were defined as KRT with and without CS, respectively. The primary outcome parameter was independence from KRT after 30 days. Propensity score (PS) matching was performed (predictors: myoglobin, SAPS-II, and age), and the chi-test was used. 35 pairings could be matched (mean age: 57 vs. 56 years; mean myoglobin: 27,218 vs. 26,872 ng/ml; mean SAPS-II: 77 vs. 76). The probability of kidney recovery was significantly ( = .04) higher in group 1 (31.4 vs. 11.4%, mean difference: 20.0%, odds ratio (OR): 3.6). Considering patients who survived 30 days, kidney recovery was also significantly ( = .03) higher in patients treated with CS (61.1 vs. 23.5%, mean difference: 37.6%, OR: 5.1). In conclusion, the use of CS might positively affect renal recovery in patients with severe rhabdomyolysis. A prospective randomized controlled trial is needed to confirm this hypothesis.
严重横纹肌溶解症常因肌红蛋白积聚导致急性肾损伤（AKI），需要肾脏替代治疗（KRT）。本研究旨在探讨 Cytosorb®（CS）的应用是否会增加因严重横纹肌溶解症而接受 KRT 的患者的肾脏恢复率。纳入 2014 年至 2021 年间肌红蛋白浓度>10000ng/ml 且接受 KRT 的成年患者。排除标准为慢性肾脏病和纳入研究前的 CS 治疗。第 1 组和第 2 组分别定义为接受和未接受 CS 的 KRT。主要观察参数为 30 天后是否能脱离 KRT。进行倾向评分（PS）匹配（预测因子：肌红蛋白、SAPS-II 和年龄），并使用卡方检验。可以匹配 35 对（平均年龄：57 岁比 56 岁；平均肌红蛋白：27218 比 26872ng/ml；平均 SAPS-II：77 比 76）。第 1 组（31.4%比 11.4%，平均差异：20.0%，优势比（OR）：3.6）肾脏恢复的概率显著更高（ = .04）。考虑到存活 30 天的患者，接受 CS 治疗的患者的肾脏恢复也显著更高（61.1%比 23.5%，平均差异：37.6%，OR：5.1）。总之，CS 的使用可能会对严重横纹肌溶解症患者的肾脏恢复产生积极影响。需要进行前瞻性随机对照试验来证实这一假设。
