Predictive value of myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis
CCCF ePoster library. KANDASAMY S. Oct 4, 2017; 198149; 79 Disclosure(s): Nothing to disclose
Prof. Dr. SUBRAMANI KANDASAMY
Prof. Dr. SUBRAMANI KANDASAMY
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Abstract
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Predictive value of myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis

1. KANDASAMY SUBRAMANI 1

2. NITHIN ABRAHAM 1

3. GIJOE GEORGE JACOB 1

4. SHOMA V RAO 1

5. CHAKRAVARTHY JOEL JACOB 2

6. ARUN K ANIL



1 SURGICAL ITENSIVE CARE UNIT, CHRISTIAN MEDICAL COLLEGE, VELLORE, INDIA

2 DEPT OF ANAESTHESIA, BAPTIST HOSPITAL, BANGALORE, INDIA


Introduction 
Rhabdomyolysis (RM) is a clinical syndrome secondary to skeletal muscle injury (1-4). The products of muscle breakdown, notably myoglobin causes renal failure (1-4). Traditionally, serum Creatinephosphokinase (CPK) is being measured to assess and manage RM to prevent acute kidney injury (AKI)(4). When myoglobin is the direct cause of renal injury, estimation of serum myoglobin than CPK, a surrogate marker in RM would be more reliable in assessing the risk of AKI severity and guide the management of RM(5). This study is an attempt to establish serum myoglobin levels which would predict establishment of renal failure in RM, compared to serum CPK in patients treated with “crush protocol”.
Objectives
Primary: of the study is to determine if serum myoglobin is a more reliable marker than CPK for development of AKI in traumatic RM.
Secondary:
a) To determine serum myoglobin level which predicts development of AKI
b) To determine need for renal replacement therapy (RRT).
c) To determine duration of mechanical ventilation (MV), ICU length of stay (ICULOS) and in hospital mortality in patients with and without AKI.
Methods
A prospective observational study in with traumatic RM. Inclusion criteria: Age (18-70yrs), trauma induced RM (excluding compartment syndrome). Exclusion criteria: Patients with chronic renal failure and RM due to other aetiologies. Informed consent or assent was obtained as appropriate. Patients admitted following trauma were screened and twere recruited when serum CPK was >5,000 IU/L during screening or subsequently during the course of ICU admission. All patients received standard treatment including intravascular volume optimization and hemodynamic stabilisation along with initiation of “crush protocol” (Fig:1) when serum CPK >5,000 IU/L. Serum myoglobin (Roche Diagnostics electrochemiluminiscent assay) was estimated along with CPK. Urine pH was determined 8th hourly as part of crush protocol. Renal function was monitored with hourly urine output and serum Creatinine. AKI was diagnosed using AKIN criteria(6).
The discriminating capacity to determine AKI using peak serum myoglobin and peak CPK levels were analysed using the ROC curve and optimal cut off values were chosen. Categorical data were expressed as frequency and percentages. Continuous variables are presented as mean (SD) or median (IQR) based on normality. The relationship between categorical variables and AKI was analysed using the Chi-square test. The relationship between continuous variables and AKI was analysed using the independent t-test or rank sum test based on normality. All data was analysed using STATA I/C 13.1 version.
Results: (DETAILED IN Table 1)
Of the 14 patients with AKI, 10 had stage 1, 2 each had stage 2 and 3 AKI and one patient needed RRT. To predict AKI, peak serum myoglobin value of ≥5,160ng/ml was found to have 78.57% sensitivity and 79.17% specificity and peak CPK value of ≥12,388U/L was found to have 64.29% sensitivity and 59.21% specificity. Development of AKI did not increase ICULOS, duration of MV or Mortality.
Conclusion: Following traumatic RM, in patients on crush protocol, serum myoglobin is a more sensitive and specific marker than serum CPK for predicting AKI. Myoglobin level >5,000ng/l is associated with an increased risk of AKI. Monitoring serum myoglobin is useful for identification of risk of AKI and response to therapy in traumatic RM. Serum myoglobin can be used to prognosticate AKI in traumatic rhabdomyolysis.

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