Admission Characteristics and Outcomes of ED Patients With Rhabdomyolysis

Abstract

Objective: Rhabdomyolysis is a potentially life-threatening syndrome characterized by muscle necrosis and the release of potentially toxic intracellular muscle constituents into the circulation. Acute kidney injury (AKI) is the most important complication of rhabdomyolysis and is associated with increased risk of all-cause mortality. The main objectives of this study were (1) to characterize the most common etiologies of rhabdomyolysis and (2) to determine the complications and outcomes (rhabdomyolysis-induced AKI, need for renal replacement therapy [RRT] and, 28-day mortality) in our sample. 

Material and Methods: This retrospective, cross sectional, and single-center study was conducted in the ED of university hospital between January 1, 2013, and December 31, 2013. We analyzed the clinical spectrum and evaluated the complications and outcomes for each patient. 

Results: Forty-three eligible cases were enrolled in the study. The mean age was 52.0±21.9 years (range 16 to 92), and 81.4% were men. The two most common causes of rhabdomyolysis in this sample were trauma and infections (n=16; 37.2% and n=12; 27.9%, respectively). AKI occurred in 23 patients (53.4%), 13 of whom (30.2%) required RRT. All-cause 28-day mortality rate was 44.2% (n=19). The nonsurvival group had significantly increased peak creatinine level, increased phosphate level, and prolonged aPTT (P <.001, P =.003, and P =.001, respectively).

Conclusion: A substantial proportion of patients with rhabdomyolysis developed the complications of AKI and required RRT. Early recognition and aggressive fluid replacement should be considered for ED patients with rhabdomyolysis.

Keywords

• Rhabdomyolysis, acute kidney injury, renal replacement therapy

Admission Characteristics and Outcomes of ED Patients With Rhabdomyolysis

Abstract

References

1. Warren JD, Blumbergs PC, Thompson PD. Rhabdomyolysis: a review. Muscle Nerve 2002;25:332-47.
2. Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis - an overview for clinicians. Crit Care 2005;9:158-69.
3. Khan FY. Rhabdomyolysis: a review of the literature. Neth J Med 2009;67:272-83.
4. Bagley WH, Yang H, Shah KH. Rhabdomyolysis. Intern Emerg Med 2007;2:210-8.
5. Giannoglou GD, Chatzizisis YS, Misirli G. The syndrome of rhabdomyolysis: Pathophysiology and diagnosis. Eur J Intern Med 2007;18:90-100.
6. Elsayed EF, Reilly RF. Rhabdomyolysis: a review, with emphasis on the pediatric population. Pediatr Nephrol 2010;25:7-18.
7. Gabow PA, Kaehny WD, Kelleher SP. The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982;61:141-52.
8. Chatzizisis YS, Misirli G, Hatzitolios AI, Giannoglou GD. The syndrome of rhabdomyolysis: complications and treatment. Eur J Intern Med 2008;19:568-74.

9. Chen CY, Lin YR, Zhao LL, Yang WC, Chang YJ, Wu HP.. Clinical factors in predicting acute renal failure caused by rhabdomyolysis in the ED. Am J Emerg Med 2013;31:1062-6.
10. Oshima Y. Characteristics of drug-associated rhabdomyolysis: analysis of 8,610 cases reported to the U.S. Food and Drug Administration. Intern Med 2011;50:845-53.
11. Campana C, Griffin PL, Simon EL. Caffeine overdose resulting in severe rhabdomyolysis and acute renal failure. Am J Emerg Med 2014;32:111.e3-4.
12. Boutaud O, Roberts LJ II. Mechanism-based therapeutic approaches to rhabdomyolysis-induced renal failure . Free Radic Biol Med 2011;51:1062-7.
13. Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury. N Engl J Med 2009; 361:62-72.
14. Holt S, Moore K. Pathogenesis of renal failure in rhabdomyolysis: the role of myoglobin. Exp Nephrol 2000;8:72-6.
15. Heyman SN, Rosen S, Fuchs S, Epstein FH, Brezis M. Myoglobinuric acute renal failure in the rat: a role for medullary hypoperfusion, hypoxia, and tubular obstruction. J Am Soc Nephrol 1996;7:1066-74.
16. Rodríguez E, Soler MJ, Rap O, Barrios C, Orfila MA, Pascual J. Risk factors for acute kidney injury in severe rhabdomyolysis. PLoS One 2013;18:8:e82992.
17. Eyuboglu T, Derinoz O. Rhabdomyolysis due to isoniazid poisoning resulting from the use of intramuscular pyridoxine. Turk J Pediatr 2013;55:328-30.
18. Yilmaz S, Demircioğlu F, Oren H, Güneş B, Irken G. Rhabdomyolysis due to Escherichia coli sepsis in three pediatric patients with acute lymphoblastic leukemia. Pediatr Hematol Oncol 2009;26:57-62.
19. Kasaoka S, Todani M, Kaneko T, Kawamura Y, Oda Y, Tsuruta R, et al. Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis. J Crit Care 2010;25:601-4.
20. Adams BD, Arbogast CB: Rhabdomyolysis. In Adams JG, Barton ED, Collings JL (eds): Emergency Medicine: Clinical Essentials. 2nd ed. Saunders, 2013, pp 1429-38.
21. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
22. Macdonald R, Rosner Z, Venters H. Case series of exercise-induced rhabdomyolysis in the New York City jail system. Am J Emerg Med. 2014;32:466-7.
23. Zimmerman JL, Shen MC. Rhabdomyolysis. Chest 2013;144:1058-65.
24. Graves EJ, Gillum BS. Detailed diagnoses and procedures, National Hospital Discharge Survey, 1995. Vital Health Stat 1997 Nov;(130):1-146.
25. McMahon GM, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med 2013;173:1821-8.
26. Mannix R, Tan ML, Wright R, Baskin M.. Acute pediatric rhabdomyolysis: causes and rates of renal failure. Pediatrics 2006;118:2119-25.
27. Luck RP, Verbin S. Rhabdomyolysis: a review of clinical presentation, etiology, diagnosis, and management. Pediatr Emerg Care 2008;24:262-8.
28. Holmes JF, McGahan JP, Wisner DH. Rate of intra-abdominal injury after a normal abdominal computed tomographic scan in adults with blunt trauma. Am J Emerg Med 2012;30:574-9.
29. Yanturali S, Cete Y, Oktay C, Eray O, Atilla R, Cevik AA, et al. Diagnostic value of ıntraabdominal pressure measurement in blunt abdominal trauma patients. Turk J Emerg Med 2004;4:105-8.
30. Baydın A, Yardan T, Guven H, Dervisoglu A, Otal Y, Eden AO, et al. The relation of the lactate, base excess and Injury Severity Scores with mortality in trauma. Turk J Emerg Med 2007;7:97-101.
31. Dur A, Cander B, Koçak S, Girisgin S, Gul M, Koyuncu F. Multiple trauma patients and trauma scoring systems in emergency-intensive care unit. JAEM 2009;8:24-7.
32. Altunci YA, Aldemir M, Guloglu C, Ustundag M, Orak M.. The effective factors in emergency department observation on hospitalization requirement and mortality in blunt trauma patients. JAEM 2010:9:117-20.
33. Fernandez WG, Hung O, Bruno GR, Galea S, Chiang WK. Factors predictive of acute renal failure and need for hemodialysis among ED patients with rhabdomyolysis. Am J Emerg Med 2005;23:-7.
34. Delaney KA, Givens ML, Vohra RB. Use of RIFLE criteria to predict the severity and prognosis of acute kidney injury in emergency department patients with rhabdomyolysis. J Emerg Med 2012;42:521-8.
35. Talving P, Karamanos E, Skiada D, Lam L, Teixeira PG, Inaba K, et al. Relationship of creatine kinase elevation and acute kidney injury in pediatric trauma patients. J Trauma Acute Care Surg 2013;74:912-6.
36. Bhavsar P, Rathod KJ, Rathod D, Chamania CS. Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients. Indian J Surg 2013;75:17-21.
37. Brown CV, Rhee P, Chan L, Evans K, Demetriades D, Velmahos GC. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma 2004;56:1191-96.