Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis

Baeza‐Trinidad, Ramón; Brea-Hernando, Ángel; Morera-Rodriguez, S.; Brito-Diaz, Y.; Sanchez-Hernandez, S.; Bikri, Laila El; Ramalle-Gómara, Enrique; Garcia-Alvarez, Jorge

doi:10.1111/imj.12815

Cited by 40 publications

(37 citation statements)

References 19 publications

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“…RRT renal replacement therapy ischemia were the primary causes of severe rhabdomyolysis. In line with previous studies, it is worth noting that despite multiorgan failure, and the need of aggressive therapies as mechanical ventilation and vasoactive drugs, the mortality rate of the current cohort was relatively low (10.9% at day 28) [3,18].…”

Section: Discussionsupporting

confidence: 88%

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Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients

Candela

Silva

Georges

et al. 2020

Ann. Intensive Care

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Background: Rhabdomyolysis is a life-threatening disease that can lead to severe hyperkalemia, acute kidney injury (AKI) and hypovolemic shock. The predictive factors of AKI and acute to chronic kidney disease (CKD) transition remain poorly described. Methods: This multicenter retrospective study enrolled 387 patients with severe rhabdomyolysis (CPK > 5000 U/L). Primary end-point was the development of severe AKI, defined as stage 2 or 3 of KDIGO classification. Secondary endpoints included the incidence of AKI to CKD transition. Results: Among the 387 patients, 315 (81.4%) developed AKI, including 171 (44.1%) with stage 3 AKI and 103 (26.6%) requiring RRT. Stage 2-3 AKI was strongly correlated with serum phosphate, potassium and bicarbonate at admission, as well as myoglobin over 8000 U/L and the need for mechanical ventilation. 42 patients (10.8%) died before day 28. In the 80 patients with available eGFR values both before and 3 months after the rhabdomyolysis, the decrease in eGFR (greater than 20 mL/min/1.73 m 2 in 23 patients; 28.8%) was correlated to the severity of the AKI and serum myoglobin levels > 8000 U/L at admission. Conclusions: Severe rhabdomyolysis leads to AKI in most patients admitted to an ICU. Mechanical ventilation and severity of the rhabdomyolysis, including myoglobin level, are associated with the risk of stage 2-3 AKI. The long-term renal decline is correlated to serum myoglobin at admission.

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Section: Discussionsupporting

confidence: 88%

“…Rhabdomyolysis is a frequent, life-threatening condition that develops solely or in combination with an underlying acute condition. Large studies specifically dedicated to severe rhabdomyolysis are scarce, and mainly rely on registries, thus precluding an accurate characterization of the predictive factors of severe AKI [5,12,18,19].…”

Section: Discussionmentioning

confidence: 99%

Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients

Candela

Silva

Georges

et al. 2020

Ann. Intensive Care

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“…All cases developed neurotoxicity with symptoms of lethargy, delirium, and even neuroleptic malignant syndrome (NMS) (4 of 7 cases). NMS is characterized by delirium, muscular rigidity, fever, and autonomic nervous system dysregulation with typically high levels of creatine phosphokinase but not necessary in elevation of creatinine [13, 14]. Furthermore, our report specially showed the change of renal function in detail compared to previous reports.…”

Section: Discussionmentioning

confidence: 59%

Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review

Hsu

Lee

et al. 2016

BMC Pharmacol Toxicol

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BackgroundCombination lithium, a mood stabilizer, and risperidone, an atypical antipsychotic drug, is widely used for treatment of psychotic disorders. Rare reports concern severe adverse drug reaction in multiple organic systems with their combined use. We report two episodes of neurotoxicity and nephrotoxicity in a patient following the combined use of lithium and risperidone.Case presentationA 55-year-old male had a diagnosis of schizoaffective disorder at the age of 51. He was initially treated with a combination of lithium and olanzapine 5 to 15 mg/day for 2 years. He was admitted to psychiatric ward at the age of 53 due to manic episode with psychotic feature. Because of poor blood sugar control, we switched olanzapine 20 mg/day to risperidone 4.5 mg/day with combination of lithium 900mg/day. The patient presented neurotoxicity, neuroleptic-malignant-syndrome like symptoms, and nephrotoxicity, elevation of blood creatinine and decreased urine output few days later. These signs were fully recovered within 2 days after we discontinued all medications and gave normal saline hydration. Then we re-administered decreased dosage of lithium 600 mg/day and risperidone 3 mg/day, and the similar episode occurred again 3 days later. All drugs were discontinued again, then his delirium resolved and abnormal data returned to normal 1 day later. Finally, the patient was treated with risperidone 2 mg/day as monotherapy, and no episode of neurotoxicity and nephrotoxicity appeared in the following 2 years.ConclusionsThe case exemplifies neurotoxicity and nephrotoxicity after combined use of lithium and risperidone. These adverse effects resolved soon after discontinuing these medications and adequate hydration. Clinicians should be cautious about neurological and renal adverse effects.

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“…[11][12][13] Other studies examining mortality from all causes of rhabdomyolysis report rates of 5 -24%. [6,8,14] …”

Section: Discussionmentioning

confidence: 99%

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

et al. 2017

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Background. Crush injury secondary to sjambok beatings is a well-described phenomenon in southern Africa. Owing to a number of factors, it can result in acute kidney injury (AKI). In 1992, Muckart et al. described a risk stratification system using venous bicarbonate (VB) that can be used in the management of these patients. Objective. To validate this score in the modern era of AKI risk stratification. Methods. A retrospective study was performed on a local trauma database from June 2010 to December 2012. All patients with crush injury from sjambok/blunt instrument beatings were included in the analysis. VB was compared with the Kidney Disease Improving Global Outcomes scoring system for AKI. Serum base excess (BE) and creatine kinase were also examined as biomarkers. The endpoints were the need for renal replacement therapy (RRT) and mortality. Results. Three hundred and ten patients were included. The overall mortality rate was 1.9%, 14.8% of patients had AKI, and 3.9% required RRT. Both VB and BE performed well in RRT prediction, with areas under the receiver operating characteristic curve of 0.847 (95% confidence interval (CI) 0.756 -0.938; p<0.001) and 0.871 (95% CI 0.795 -0.947; p<0.001), respectively. The sensitivity and specificity of BE were 83.3% and 80.2% at an optimal cut-point of -7.25 mmol/L, while those of VB were 83.3% and 79.5% at an optimal cut-point of 18.85 mmol/L. VB was significantly different across the AKI risk groups (p<0.001), in keeping with the original Muckart risk stratification system. Conclusion. The risk stratification score using VB is valid and should continue to be used as a tool in the management of patients with sjambok injuries. BE performs well in predicting the need for RRT, with a value of <-7.25 mmol/L indicating severe injury.

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Creatinine as predictor value of mortality and acute kidney injury in rhabdomyolysis

Abstract: Despite being a diagnostic marker for RB, initial CK levels do not predict mortality. However, creatinine initial levels are related to progression to acute renal injury and mortality at 30 days.

Cited by 40 publications

References 19 publications

Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients

Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients

Neurotoxicity and nephrotoxicity caused by combined use of lithium and risperidone: a case report and literature review

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

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