Massive Rhabdomyolysis; A Rare Cause of Hepatocellular Dysfunction

Manasra, Abdel Rahman Al; Shattarah, Osama

doi:10.12659/ajcr.906452

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…The CK/ALT ratio was smaller among patients with liver failure (4 vs 34 [14-86], P < .0001). ICU stays were longer for intense RM patients compared with the no intense RM group (7 [4-18] days vs 4 [2][3][4][5][6][7][8][9][10][11] days, P < .001). Intense RM patients required more RRT (4.1% vs 20.0%, P < .001) and had a higher incidence of liver failure (4.6% vs 18.2%, P < .001) compared with the no intense RM group.…”

Section: Resultsmentioning

confidence: 99%

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Study of the Relationship Between Liver Function Markers and Traumatic Rhabdomyolysis: A Retrospective Study of Hemorrhagic Patients Admitted to Intensive Care Unit in a Level I Trauma Center

Martinez

Liaud-Laval

Laitselart

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Traumatic rhabdomyolysis (RM) is common and contributes to the development of medical complications, of which acute renal failure is the best described. Some authors have described an association between elevated aminotransferases and RM, suggesting the possibility of associated liver damage. Our study aims to evaluate the relationship between liver function and RM in hemorrhagic trauma patients. METHODS: This is a retrospective observational study conducted in a level 1 trauma center analyzing 272 severely injured patients transfused within 24 hours and admitted to intensive care unit (ICU) from January 2015 to June 2021. Patients with significant direct liver injury (abdominal Abbreviated Injury Score [AIS] >3) were excluded. Clinical and laboratory data were reviewed, and groups were stratified according to the presence of intense RM (creatine kinase [CK] >5000 U/L). Liver failure was defined by a prothrombin time (PT)-ratio <50% and an alanine transferase (ALT) >500 U/L simultaneously. Correlation analysis was performed using Pearson’s or Spearman’s coefficient depending on the distribution after log transformation to evaluate the association between serum CK and biological markers of hepatic function. Risk factors for the development of liver failure were defined with a stepwise logistic regression analysis of all relevant explanatory factors significantly associated with the bivariate analysis. RESULTS: RM (CK >1000 U/L) was highly prevalent in the global cohort (58.1%), and 55 (23.2%) patients presented with intense RM. We found a significant positive correlation between RM biomarkers (CK and myoglobin) and liver biomarkers (aspartate transferase [AST], ALT, and bilirubin). Log-CK was positively correlated with log-AST (r = 0.625, P < .001) and log-ALT (r = 0.507, P < .001) and minimally with log-bilirubin (r = 0.262, P < .001). Intensive care unit stays were longer for intense RM patients (7 [4–18] days vs 4 [2–11] days, P < .001). These patients required increased renal replacement therapy use (4.1% vs 20.0%, P < .001) and transfusion requirements. Liver failure was more common (4.6% vs 18.2%, P < .001) for intense RM patients. It was associated with bivariate and multivariable analysis with intense RM (odds ratio [OR], 4.51 [1.11–19.2]; P = .034), need for renal replacement therapy, and Sepsis-Related Organ Failure Assessment Score (SOFA) score on day 1. CONCLUSIONS: Our study established the presence of an association between trauma-related RM and classical hepatic biomarkers. Liver failure was associated with the presence of intense RM in bivariate and multivariable analysis. Traumatic RM could have a role in the development of other system failures, specifically at the hepatic level, in addition to the already known and well-described renal failure.

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Section: Resultsmentioning

confidence: 99%

“…Few works have described an association between liver enzymes and RM, suggesting a potential role in the development of liver failure that could influence the management of patients with RM. [10][11][12][13]…”

Section: Rationalementioning

confidence: 99%

Study of the Relationship Between Liver Function Markers and Traumatic Rhabdomyolysis: A Retrospective Study of Hemorrhagic Patients Admitted to Intensive Care Unit in a Level I Trauma Center

Martinez

Liaud-Laval

Laitselart

et al. 2023

Anesthesia &Amp; Analgesia

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“…3,4 Our patient rapidly developed right lower extremity edema, concerning for compartment syndrome. Transaminase elevation has been described in rhabdomyolysis, 8,9 however there is also a concomitant elevation of CPK. 8–10 Our patient had peak CPK levels of 513 µ/L, which is inconsistent with rhabdomyolysis and compartment syndrome as those conditions are generally associated with CPK levels in the thousands.…”

Section: Discussionmentioning

confidence: 98%

“…Transaminase elevation has been described in rhabdomyolysis, 8,9 however there is also a concomitant elevation of CPK. 8–10 Our patient had peak CPK levels of 513 µ/L, which is inconsistent with rhabdomyolysis and compartment syndrome as those conditions are generally associated with CPK levels in the thousands. 10 Nonetheless, evolving limb injury due to impaired venous blood flow from an oversized catheter may account for the discrepancy in transaminase ratio.…”

Section: Discussionmentioning

confidence: 98%

Acute Budd Chiari syndrome in an ECMO patient

Butzko

Narasimhan

2021

Perfusion

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Introduction: Point-of-care ultrasound (POCUS) is widely utilized to make timely decisions regarding patient care. This approach allowed us to diagnose the cause of acutely rising transaminases in a patient in severe ARDS secondary to influenza pneumonia requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO). Case report: A 36-year-old female presented with acute hypoxemic respiratory failure secondary to influenza A infection. Within 24 hours, she required intubation and met severe ARDS criteria with a PaO2/FiO2 ratio of 62. She was managed with high PEEP and low tidal volume ventilation strategy, however her clinical status continued to deteriorate and the decision was made to pursue VV-ECMO. Within hours of cannulation her aspartate aminotransferase (AST) dramatically increased from 736 to 4512 µ/L, with concurrent mild increases in alanine aminotransferase (ALT) and creatine phosphokinase (CPK). Point-of-care ultrasound was performed which revealed a complete absence of flow in the hepatic vein, secondary to acute obstruction by an 25-French drainage catheter for the ECMO circuit. The catheter was exchanged with a smaller French catheter and the patient’s transaminases and CPK levels quickly decreased and returned to normal within several days. Discussion: Budd-Chiari syndrome (BCS) is a rare but potentially life-threatening condition caused by acute obstruction of hepatic vein blood flow that can lead to fulminant liver failure if left untreated. BCS is usually caused by a hepatic vein thrombus, however any mechanical obstruction can lead to the same pathology. Point-of-care ultrasound lead to a prompt diagnosis and allowed for quick action to correct the obstruction. Although BCS is not a common problem with VV-ECMO, the syndrome should always be on the differential of any patient on VV-ECMO with acutely rising transaminases. Conclusion: Ultrasound played an integral role in providing a crucial diagnosis of BCS secondary to obstruction by an ECMO drainage catheter.

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A rare presentation of rhabdomyolysis-associated acute kidney injury and hepatocellular dysfunction with persistent proximal weakness of lower limb

Kumar,

Binoy

2024

IJMS

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Exercise-induced rhabdomyolysis (ERM) is a pathophysiological condition where skeletal muscles break down, releasing their contents into the bloodstream. Common complications include acute kidney injury (AKI), compartment syndrome, and disseminated intravascular coagulation, with AKI being the most serious. Rarely, ERM may also be associated with hepatocellular dysfunction, leading to confusion in diagnosis. The reason for elevated liver enzymes in this condition is not yet fully understood. In addition, persistent weakness in the lower limbs after rhabdomyolysis is rarely reported. In this particular case, the patient presented with these symptoms for the first time, prompting consideration of inherited metabolic disorders and genetic mutations. This case study highlights a rare instance of hepatocellular dysfunction and persistent limb weakness resulting from ERM, which necessitated prolonged dialysis for renal recovery.

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Massive Rhabdomyolysis; A Rare Cause of Hepatocellular Dysfunction

Cited by 3 publications

References 15 publications

Study of the Relationship Between Liver Function Markers and Traumatic Rhabdomyolysis: A Retrospective Study of Hemorrhagic Patients Admitted to Intensive Care Unit in a Level I Trauma Center

Study of the Relationship Between Liver Function Markers and Traumatic Rhabdomyolysis: A Retrospective Study of Hemorrhagic Patients Admitted to Intensive Care Unit in a Level I Trauma Center

Acute Budd Chiari syndrome in an ECMO patient

A rare presentation of rhabdomyolysis-associated acute kidney injury and hepatocellular dysfunction with persistent proximal weakness of lower limb

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