title: Rhabdomyolysis: risk factors and incidence in polytrauma patients in the absence of major disasters.
abstract: OBJECTIVE
  Rhabdomyolysis is a syndrome caused by musculoskeletal tissue damage that leads to the release of large amounts of intracellular elements, which particularly affect renal function. The most common causes are severe trauma, ischemia, surgical procedures, and drug abuse. We aimed to determine the incidence of rhabdomyolysis by measuring muscle injury markers (CK, myoglobin), to identify pre/post-admission as well as iatrogenic risk factors for rhabdomyolysis in severe polytrauma, to clarify the relevance of orthopedic injuries and surgical treatment in the onset/worsening of rhabdomyolysis, and to correlate risk factors with its main complication-acute renal failure (ARF).
  
  
  METHODS
  Prospective study of severe polytrauma patients (Injury Severity Score (ISS) >15), with CK and myoglobin values measured at admission and after 24, 48, and 72 h. Peak values, variations between admission and peak, and variations between admission and day 3 were all determined. The correlations of those values with the onset of ARF and other negative outcomes were assessed.
  
  
  RESULTS
  A total of 57 consecutive patients with a median ISS of 29 were included. ARF was present in 20 patients (38 %). CK-0 level was correlated with male gender (p < 0.027) and ISS (0.014); Mb-0 level was correlated with hypovolemic shock (0.003) and skeletal fracture (p < 0.043). CK-max was correlated with surgery (p < 0.038) and surgery duration (p < 0.014); Mb-max was correlated with surgery (p < 0.002) and anesthesia duration (p < 0.005). Δ-CK was correlated with surgery (p < 0.01) and surgery duration (p < 0.017), and Δ0-3-CK was correlated with surgery (p < 0.042). Logistic regression analysis found relationships between Δ0-3-CK and both ICU admission (p < 0.003) and MODS (p < 0.012), and between Mb-max and ARF (p < 0.034).
  
  
  CONCLUSIONS
  We found that a large number of factors are implicated in CK and Mb variations. Rhabdomyolysis is a very frequent complication, but increase in CK marker alone does not seem to be correlated with the incidence of ARF. Therefore, Mb level should be considered in this group of patients.
authors.affiliation: Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal. antonionogueirasousa@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Sousa
authors.affiliation: Emergency and Intensive Care Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal. josearturpaiva@gmail.com.
authors.forename: J A
authors.initials: JA
authors.lastname: Paiva
authors.affiliation: Anesthesiology Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal. sarafonseca@sapo.pt.
authors.forename: S
authors.initials: S
authors.lastname: Fonseca
authors.affiliation: Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal. fred_raposo@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Raposo
authors.affiliation: Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal. luisfilipealmeidavalente@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Valente
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA. vyasdr@upmc.edu.
authors.forename: D
authors.initials: D
authors.lastname: Vyas
authors.affiliation: Department of Decision and Information Sciences in Health, Faculdade de Medicina da UP, Alameda Prof. Hernani Monteiro, Porto, Portugal. orquidiaribeiro@gmail.com.
authors.forename: O
authors.initials: O
authors.lastname: Ribeiro
authors.affiliation: Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernani Monteiro, Porto, Portugal. ruialexpinto@yahoo.com.
authors.forename: R
authors.initials: R
authors.lastname: Pinto
keywords: Emergency surgery; Polytrauma; Soft tissue injuries; Surgical critical care; Trauma systems
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