Advertisement

Intensive Care Medicine

, Volume 29, Issue 7, pp 1121–1125 | Cite as

Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey

  • Arthur R. de MeijerEmail author
  • Bernard G. Fikkers
  • Marinus H. de Keijzer
  • Baziel G. M. van Engelen
  • Joost P. H. Drenth
Original

Abstract

Objective

To evaluate the risk factors for the development of acute renal failure (ARF) in severe rhabdomyolysis.

Design

Observational historical cohort study.

Setting

General intensive care unit of a university hospital.

Patients

Twenty-six patients with severe rhabdomyolysis, who were admitted between July 1996 and July 2001.

Measurements and results

Clinical and laboratory data were reviewed and groups were stratified according to presence or absence of acute renal failure. The underlying cause of rhabdomyolysis was ischemia by vascular obstruction (50%), crush injury by trauma (23%), sepsis (11.5%), heatstroke/hyperthermia (11.5%) and hyponatremia in a single patient. Mean creatine kinase (CK) level was 38,351±35,354 U/l on admission and rose further in all patients (mean: 59,747±67,514 U/l). Renal failure developed in 17 patients (65%). Serum CK levels correlated with onset of ARF, as these patients had significantly higher admission and peak serum CK concentrations. Patients with ARF had a higher mortality (59% vs 22%).

Conclusion

In our cohort of patients with severe rhabdomyolysis the level of serum CK predicted the development of ARF. Although our results suggest that series of CK determination might be beneficial for the evaluation of the effect of therapy, the value of CK determination as a prognostic tool is limited, given the wide range of CK levels.

Keywords

Rhabdomyolysis Acute renal failure Intensive care Creatine kinase Myoglobin 

References

  1. 1.
    Slater MS, Mullins RJ (1998) Rhabdomyolysis and myoglobinuric renal failure in trauma and surgical patients: a review. J Am Coll Surg 186:693–716CrossRefPubMedGoogle Scholar
  2. 2.
    Gabow PA, Kaehny WD, Kelleher SP (1982) The spectrum of rhabdomyolysis. Medicine 61:141–152PubMedGoogle Scholar
  3. 3.
    Vanholder R, Sever MS, Erek E, Lameire N (2000) Rhabdomyolysis. J Am Nephrol 11:1553–1561Google Scholar
  4. 4.
    Vanholder R, Sever MS, Erek E, Lameire N (2000) Acute renal failure related to the crush syndrome: towards an era of seismo-nephrology? Nephrol Dial Transplant 15:1517–1521Google Scholar
  5. 5.
    Bollaert PE, Frisoni A (1999) Epidemiology, mechanisms and clinical features of rhabdomyolysis. Minerva Anestesiol 65:245–249PubMedGoogle Scholar
  6. 6.
    Visweswaran P, Guntupalli J (1999) Rhabdomyolysis. Crit Care Clin 15:415–428PubMedGoogle Scholar
  7. 7.
    Betrosian A, Thireos E, Kofinas G, Balla M, Papanikolaou M, Georgiadis G (1999) Bacterial sepsis-induced rhabdomyolysis. Intensive Care Med 25:469–474CrossRefPubMedGoogle Scholar
  8. 8.
    Koppel C (1989) Clinical features, pathogenesis and management of drug-induced rhabdomyolysis. Med Toxicol Adverse Drug Experience 4:108–126Google Scholar
  9. 9.
    Knochel JP (1993) Mechanisms of rhabdomyolysis. Curr Opin Rheumatol 5:725–731PubMedGoogle Scholar
  10. 10.
    Defraigne JO, Pincemail J (1998) Local and systemic consequences of severe ischemia and reperfusion of the skeletal muscle. Physiopathology and prevention. Acta Chir Belg 4:176–186Google Scholar
  11. 11.
    Hojs R, Ekart R, Sinkovic A, Hojs-Fabjan T (1999) Rhabdomyolysis and acute renal failure in intensive care unit. Ren Fail 21:675–684PubMedGoogle Scholar
  12. 12.
    Holt SG, Moore KP (2001) Pathogenesis and treatment of renal dysfunction in rhabdomyolysis. Intensive Care Med 27:803–811PubMedGoogle Scholar
  13. 13.
    David WS (2000) Myoglobinuria. Neurol Clin 18:215–243PubMedGoogle Scholar
  14. 14.
    Abassi ZA, Hoffman A, Better OS (1998) Acute renal failure complicating muscle crush injury. Semin Nephrol 18:558–565PubMedGoogle Scholar
  15. 15.
    Guglielminotti J, Guidet B (1999) Acute renal failure in rhabdomyolysis. Minerva Anestesiol 65:250–255PubMedGoogle Scholar
  16. 16.
    Nimmo GR, Lambie AT, Cumming AD (1989) Rhabdomyolysis and acute renal failure. Intensive Care Med 15:486–487PubMedGoogle Scholar
  17. 17.
    Nespoli A, Corso V, Matterel D, Valerio M, Nespoli L (1999) The management of shock and local injury in traumatic rhabdomyolysis. Minerva Anestesiol 65:256–262PubMedGoogle Scholar
  18. 18.
    Shimazu T, Yoshioka T, Nakata Y, Ishikawa K, Mizishima Y, Morimoto F, Kishi M, Takaoka M, Tanaka H, Iwai A, Hiraide A (1997) Fluid resuscitation and systemic complications in crush syndrome: 14 Hanshin-Awaji earthquake patients. J Trauma 42:641–646PubMedGoogle Scholar
  19. 19.
    Better OS, Stein JH (1990). Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med 322:825–829Google Scholar
  20. 20.
    Schenk MR, Beck DH, Nolte M, Kox WJ (2001) Continuous veno-venous hemofiltration for the immediate management of massive rhabdomyolysis after fulminant malignant hyperthermia in a bodybuilder. Anesthesiology 94:1139–1141PubMedGoogle Scholar
  21. 21.
    Vivino G, Antonelli M, Moro ML, Cottini F, Conti G, Bufi M, Cannata F, Gasparetto A (1998) Risk factors for acute renal failure in trauma patients. Intensive Care Med 24:808–814CrossRefPubMedGoogle Scholar
  22. 22.
    Poels PJE, Gabreels FJM (1993) Rhabdomyolysis: a review of the literature. Clin Neurol Neurosurg 95:175–192PubMedGoogle Scholar
  23. 23.
    Beetham R (2000) Biochemical investigation of suspected rhabdomyolysis. Ann Clin Biochem 37:581–587CrossRefPubMedGoogle Scholar
  24. 24.
    Lofberg M, Tahtela R, Harkonen M, Somer H (1995) Myosin heavy chain fragments and cardiac troponins in the serum in rhabdomyolysis. Diagnostic specificity of new biochemical markers. Arch Neurol 52:1210–1214PubMedGoogle Scholar
  25. 25.
    Ward MM (1988) Factors predictive of acute renal failure in rhabdomyolysis. Arch Intern Med 148:1553–1557Google Scholar
  26. 26.
    Splendiani G, Mazzarella V, Cipriani S, Pollicita S, Rodio F, Casciani CU (2001) Dialytic treatment of rhabdomyolysis-induced acute renal failure: our experience. Ren Fail 23:183–191CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Arthur R. de Meijer
    • 1
    • 2
    Email author
  • Bernard G. Fikkers
    • 2
  • Marinus H. de Keijzer
    • 3
  • Baziel G. M. van Engelen
    • 4
  • Joost P. H. Drenth
    • 5
  1. 1.Department of Intensive CareMeander Medical CentreAmersfoortThe Netherlands
  2. 2.Department of Intensive Care MedicineUniversity Medical CentreNijmegenThe Netherlands
  3. 3.Department of Clinical ChemistryUniversity Medical CentreNijmegenThe Netherlands
  4. 4.Department of NeurologyUniversity Medical CentreNijmegenThe Netherlands
  5. 5.Department of MedicineUniversity Medical CentreNijmegenThe Netherlands

Personalised recommendations