Rhabdomyolysis and acute kidney injury in patients with traumatic spinal cord injury.
BACKGROUND
Patients with acute traumatic spinal cord injuries (SCIs) exhibit factors that, in other populations, have been associated with rhabdomyolysis.


OBJECTIVE
The aim of the study is to determine the incidence of rhabdomyolysis in patients with acute traumatic SCI admitted to the Intensive Care Unit (ICU), as well as the development of secondary acute kidney injury and associated factors.


METHODS
This was an observational, retrospective study.


METHODS
All adult patients admitted to the ICU with acute traumatic SCI who presented rhabdomyolysis, diagnosed through creatine phosphokinase (CPK) levels >500 IU/L.


METHODS
Incidence of rhabdomyolysis and subsequent renal dysfunction was calculated.


METHODS
Data about demographic variables, comorbidity, rhabdomyolysis risk factors, and variables involving SCI, severity scores, and laboratory parameters were obtained from clinical records. Multivariate logistic regression was used to identify renal injury risk factors.


RESULTS
In 2006-2014, 200 patients with acute SCI were admitted to ICU. Of these, 103 had rhabdomyolysis (incidence = 51.5%; 95% confidence interval [CI]: 44.3%-58.7%). The most typical American Spinal Injury Association classification was A (70.3%). The injury severity score was 30.3 ± 12.1 and sequential organ failure assessment (SOFA) score was 5.6 ± 3.3 points. During their stay, 57 patients (55.3%; 95% CI: 45.2%-65.4%) presented renal dysfunction (creatinine ≥1.2 mg/dL). In the multivariate analysis, variables associated with renal dysfunction were creatinine at admission (odds ratio [OR] = 9.20; P = 0.006) and hemodynamic SOFA score the day following admission (OR = 1.33; P = 0.024). Creatinine was a better predictor of renal dysfunction than the peak CPK value during the rhabdomyolysis (area under the receiver operating characteristic curve: 0.91 vs. 0.63, respectively).


CONCLUSIONS
Rhabdomyolysis is a frequent condition in patients with acute traumatic SCI admitted to the ICU, and renal dysfunction occurs in half of the cases. Creatinine values should be requested starting at the admission while neither the peak CPK values nor the hemodynamic SOFA scores could be used to properly discriminate between patients with and without renal dysfunction.
Critical Care Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, CP: 15006 A Coruña, Spain.
Rita
R
Galeiras
Critical Care Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, CP: 15006 A Coruña, Spain.
Mónica
M
Mourelo
Clinical Epidemiology and Biostatistics Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, CP: 15006 A Coruña, Spain.
Sonia
S
Pértega
Critical Care Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña, CP: 15006 A Coruña, Spain.
Amanda
A
Lista
Spinal Cord Injury Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña. CP: 15006 A Coruña, Spain.
M Elena
ME
Ferreiro
Spinal Cord Injury Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña. CP: 15006 A Coruña, Spain.
Sebastián
S
Salvador
Spinal Cord Injury Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña. CP: 15006 A Coruña, Spain.
Antonio
A
Montoto
Spinal Cord Injury Unit, Complexo Hospitalario Universitario de A Coruña, University of A Coruña. CP: 15006 A Coruña, Spain.
Antonio
A
Rodríguez
Acute kidney injury; rhabdomyolysis; spinal cord injuries
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