Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice.
BACKGROUND
Rhabdomyolysis is a clinical syndrome that comprises destruction of skeletal muscle with outflow of intracellular muscle content into the bloodstream. There is a great heterogeneity in the literature regarding definition, epidemiology, and treatment. The aim of this systematic literature review was to summarize the current state of knowledge regarding the epidemiologic data, definition, and management of rhabdomyolysis.


METHODS
A systematic search was conducted using the keywords "rhabdomyolysis" and "crush syndrome" covering all articles from January 2006 to December 2015 in three databases (MEDLINE, SCOPUS, and ScienceDirect). The search was divided into two steps: first, all articles that included data regarding definition, pathophysiology, and diagnosis were identified, excluding only case reports; then articles of original research with humans that reported epidemiological data (e.g., risk factors, common etiologies, and mortality) or treatment of rhabdomyolysis were identified. Information was summarized and organized based on these topics.


RESULTS
The search generated 5632 articles. After screening titles and abstracts, 164 articles were retrieved and read: 56 articles met the final inclusion criteria; 23 were reviews (narrative or systematic); 16 were original articles containing epidemiological data; and six contained treatment specifications for patients with rhabdomyolysis.


CONCLUSIONS
Most studies defined rhabdomyolysis based on creatine kinase values five times above the upper limit of normal. Etiologies differ among the adult and pediatric populations and no randomized controlled trials have been done to compare intravenous fluid therapy alone versus intravenous fluid therapy with bicarbonate and/or mannitol.
Universidad Autónoma de Baja California, Facultad de Medicina y Psicología, Tijuana, Baja California, Mexico.
Luis O
LO
Chavez
Universidad Popular Autónoma del Estado de Puebla, Facultad de Medicina, Puebla, Mexico.
Monica
M
Leon
Shaare Zedek Medical Center, Jerusalem, Israel.|Hadassah-Hebrew University Faculty of Medicine, Jerusalem, Israel.
Sharon
S
Einav
Foundation Surgical Hospital of Houston TX, United States, 7501 Fannin Street, Houston, TX, 77054, USA. Joseph.Varon@uth.tmc.edu.
Joseph
J
Varon
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control; D000071576:Crush Injuries / Q000150:complications; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007511:Ischemia / Q000150:complications; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009135:Muscular Diseases / Q000150:complications; D005082:Physical Exertion / Q000502:physiology; D012206:Rhabdomyolysis / Q000150:complications* / Q000503:physiopathology* / Q000628:therapy*; D012307:Risk Factors
Acute kidney injury; Myoglobinuria; Myopathy; Rhabdomyolysis