title: Risk factors for acute kidney injury in severe rhabdomyolysis.
abstract: BACKGROUND
  Acute kidney injury (AKI) is a life-threatening complication of severe rhabdomyolysis. This study was conducted to assess risk factors for AKI and to develop a risk score for early prediction.
  
  
  METHODS
  Retrospective observational cohort study with a 9-year follow-up, carried out in an acute-care teaching-affiliated hospital. A total of 126 patients with severe rhabdomyolysis defined as serum creatine kinase (CK) > 5,000 IU/L fulfilled the inclusion criteria. Univariate and logistic regression analyses were performed to determine risk factors for AKI. Based on the values obtained for each variable, a risk score and prognostic probabilities were estimated to establish the risk for developing AKI.
  
  
  RESULTS
  The incidence of AKI was 58%. Death during hospitalization was significantly higher among patients with AKI, compared to patients without AKI (19.2% vs 3.6%, p = 0.008). The following variables were independently associated with AKI: peak CK (odds ratio [OR] 4.9, 95%CI 1.4-16.8), hypoalbuminemia (< 33 mg/dL, [OR 5.1, 95%CI 1.4-17-7]), metabolic acidosis (OR 5.3, 95%CI 1.4-20.3), and decreased prothrombin time (OR 4.4, 95% CI 1.3-14.5). A risk score for AKI was calculated for each patient, with an OR of 1.72 (95%CI 1.45-2.04). The discrimination value of the predictive model was established by means of a ROC curve, with the area under the curve of 0.871 (p<0.001).
  
  
  CONCLUSIONS
  The identification of independent factors associated with AKI and a risk score for early prediction of this complication in patients with severe rhabdomyolysis may be useful in clinical practice, particularly to implement early preventive measures.
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain ; Nephrology Research Group, Institut Mar d'Investigacions Mediques, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Rodríguez
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain ; Nephrology Research Group, Institut Mar d'Investigacions Mediques, Barcelona, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Soler
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: Oana
authors.initials: O
authors.lastname: Rap
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain ; Nephrology Research Group, Institut Mar d'Investigacions Mediques, Barcelona, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Barrios
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain.
authors.forename: María A
authors.initials: MA
authors.lastname: Orfila
authors.affiliation: Department of Nephrology, Hospital del Mar, Barcelona, Spain ; Nephrology Research Group, Institut Mar d'Investigacions Mediques, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications*; D019411:Clinical Laboratory Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D012307:Risk Factors