title: Rhabdomyolysis and acute kidney injury in the injured war fighter.
abstract: BACKGROUND
  Rhabdomyolysis is a recognized complication of traumatic injury. The correlation of an elevated creatine kinase (CK) level and the development of acute kidney injury (AKI) has been studied in the civilian population. We sought to review the prevalence of rhabdomyolysis in injured war fighters and determine if peak CK levels correlate with AKI.
  
  
  METHODS
  This is a retrospective cohort study of patients admitted at a US military treatment facility from January to November 2010. Inclusion criteria were active duty patients transported after explosive, penetrating, or blunt injury. Patients with burns or non-trauma-related admissions were excluded. Rhabdomyolysis was defined as a CK level greater than 5,000 U/L. AKI was defined using the Kidney Disease: Improving Global Outcomes classification. Mann-Whitney U-tests were used to determine the significance for continuous data. Correlations were determined using Spearman's ρ. Significance was set at p < 0.05.
  
  
  RESULTS
  Of the 318 patients included in our analysis, 310 (98%) were male, and the median age was 24 years (21-28 years). Blast was the predominant mechanism of injury (71%), with a median Injury Severity Score (ISS) of 22 (16-29). Rhabdomyolysis developed in 79 patients (24.8%). The median peak CK for all patients was 4,178 U/L and ranged from 208 U/L to 120,000 U/L. Stage 1, 2, and 3 AKI developed in 56 (17.6%), 3 (0.9%), and 7 (2.2%) patients, respectively. There was a weak but statistically significant correlation between peak CK and AKI (r = 0.26, p < 0.05).
  
  
  CONCLUSIONS
  Elevated peak CK levels in the injured war fighter are weakly associated with the development of AKI but are not predictive. The development of clinical practice guidelines would help standardize treatment for rhabdomyolysis in combat casualties and would allow for standardized comparisons in future work.
  
  
  METHODS
  Epidemiologic/prognostic study, level III.
authors.affiliation: From the University of Cincinnati Medical Center (J.E.), Cincinnati, Ohio; Oregon Health & Science University (D.Z., M.S.), Portland, Oregon; San Antonio Military Medical Center (I.S.), San Antonio, Texas; Uniformed Services University of the Health Sciences (J.E., D.Z., I.S., R.F.); and Baltimore Shock Trauma (RF), Baltimore, Maryland.
authors.forename: Joel
authors.initials: J
authors.lastname: Elterman
authors.forename: David
authors.initials: D
authors.lastname: Zonies
authors.forename: Ian
authors.initials: I
authors.lastname: Stewart
authors.forename: Raymond
authors.initials: R
authors.lastname: Fang
authors.forename: Martin
authors.initials: M
authors.lastname: Schreiber
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D000328:Adult; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D008297:Male; D008889:Military Personnel; D015995:Prevalence; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000097:blood / Q000150:complications* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
chemical_list: D003402:Creatine Kinase