Yin Li Khu
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BPT1 trainee with a keen interest in General Medicine and Neurology
Aetiology And Frequency Of Poor Clinical Outcomes In Patients With Rhabdomyolysis: A Retrospective Cohort Study
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Aims:
(i) To describe mortality and need for dialysis in patients with rhabdomyolysis; (ii) To identify aetiological associations of patients with severe rhabdomyolysis; and (iii) To assess if severity of rhabdomyolysis is associated with poor clinical outcomes.
Methods:
A retrospective cohort study was conducted at a tertiary trauma centre in Melbourne from January 2010 to December 2015. All patients ≥15 years old with clinically significant rhabdomyolysis, defined as admission creatinine kinase (CK) ≥3000IU/L, were identified by matching data from clinical records with laboratory databases. Patients with CK elevation due to acute myocardial infarction were excluded. The outcomes of interest were mortality, need for dialysis and length of stay (LOS).
Results:
Among the 1368 patients with rhabdomyolysis, there were 96 deaths (8%). Sepsis was the third commonest aetiology (206, 15.0%), after trauma (852, 49.4%) and prolonged lie (255, 18.6%). Sepsis-related rhabdomyolysis was also associated with the highest mortality (11.6%). In multivariable analyses, only higher mean creatinine rise and higher peak alanine aminotransferase values were significantly associated with mortality. In total, 136 (10.0%) patients required short-term and 10 (0.7%) required long-term dialysis. Severe rhabdomyolysis (CK ≥10,000IU/L) occurred in 332 (24%) patients, and was significantly associated with statin use, history of seizure, and medication or illicit substance overdose. The severity of rhabdomyolysis) was not associated with LOS, need for long-term dialysis or death.
Conclusion:
Trauma, immobility and sepsis are the most frequent aetiologies for rhabdomyolysis, with sepsis contributing to the highest mortality. There is no correlation between the severity of rhabdomyolysis with poor clinical outcomes.
(i) To describe mortality and need for dialysis in patients with rhabdomyolysis; (ii) To identify aetiological associations of patients with severe rhabdomyolysis; and (iii) To assess if severity of rhabdomyolysis is associated with poor clinical outcomes.
Methods:
A retrospective cohort study was conducted at a tertiary trauma centre in Melbourne from January 2010 to December 2015. All patients ≥15 years old with clinically significant rhabdomyolysis, defined as admission creatinine kinase (CK) ≥3000IU/L, were identified by matching data from clinical records with laboratory databases. Patients with CK elevation due to acute myocardial infarction were excluded. The outcomes of interest were mortality, need for dialysis and length of stay (LOS).
Results:
Among the 1368 patients with rhabdomyolysis, there were 96 deaths (8%). Sepsis was the third commonest aetiology (206, 15.0%), after trauma (852, 49.4%) and prolonged lie (255, 18.6%). Sepsis-related rhabdomyolysis was also associated with the highest mortality (11.6%). In multivariable analyses, only higher mean creatinine rise and higher peak alanine aminotransferase values were significantly associated with mortality. In total, 136 (10.0%) patients required short-term and 10 (0.7%) required long-term dialysis. Severe rhabdomyolysis (CK ≥10,000IU/L) occurred in 332 (24%) patients, and was significantly associated with statin use, history of seizure, and medication or illicit substance overdose. The severity of rhabdomyolysis) was not associated with LOS, need for long-term dialysis or death.
Conclusion:
Trauma, immobility and sepsis are the most frequent aetiologies for rhabdomyolysis, with sepsis contributing to the highest mortality. There is no correlation between the severity of rhabdomyolysis with poor clinical outcomes.