Rhabdomyolysis and secondary renal failure in critically ill surgical patients.
BACKGROUND
Rhabdomyolysis accounts for up to 28% of the causes of posttraumatic acute renal failure requiring dialysis. Clinically significant rhabdomyolysis is poorly characterized biochemically and difficult to diagnose.


METHODS
A retrospective review of all surgical, trauma, burn, and pediatric surgical patients admitted to Grady Memorial Hospital in Atlanta, GA, from January 1995, through April 2002 was performed. Patients were screened for serum creatinine, base deficit, serum creatine kinase (CK) > or =1,000, presence of myoglobinuria, or if they had a clinical diagnosis of rhabdomyolysis by an attending surgeon.


RESULTS
The sequential addition of admission laboratory values for serum creatinine > or =1.5 mg/dL (positive predictive value [PPV] = 33%), base deficit < or = -4 (PPV = 52%), serum CK level > or =5,000 U/L (PPV = 80%), and myoglobinuria increases the ability to predict which patients will develop dialysis-requiring acute renal failure after an episode of rhabdomyolysis. Patients with maximum CK > or =5,000 are also at increased risk for persistent renal insufficiency (Cr > or =2.0 mg/dL).


CONCLUSIONS
An algorithm for testing at-risk surgical patients was developed and may aid in the early diagnosis of clinically significant rhabdomyolysis.
Sharp
Lindsey S
LS
Department of Surgery, Grady Memorial Hospital and Emory University School of Medicine, 69 Jesse Hill Jr. Drive SE, Atlanta, GA 30303, USA.
Rozycki
Grace S
GS
Feliciano
David V
DV
D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000175:diagnosis / Q000601:surgery; D002648:Child; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D016638:Critical Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis