Rhabdomyolysis: early prognostication of renal failure and other adverse outcomes

Management of kidney injury in critically ill patients with earthquake-induced crush syndrome: A case series of 18 patients

İNTRODUCTION: It was aimed primarily to analyze the development of acute kidney injury (AKI) and treatment management in critically ill patients who developed rhabdomyolysis due to earthquake-related crush syndrome.

METHODS

We evaluated 18 patients with crush syndrome who were admitted to the intensive care unit (ICU) after the great earthquake in February 2023 in Turkey.

RESULTS

AKI occurred in 83% (n:15) of these patients after ICU admission (AKI-1; 16.6% [n:3], AKI-2; 16.6% [n:3], and AKI-3; 50% [n:9]). While the majority of patients who developed crush syndrome were treated with high volume intravenous hydration, only 33% (n:6) of all patients required renal replacement therapy. All patients who developed AKI had complete recovery in renal functions at the end of 2 months.

CONCLUSION

There is no need for routine renal replacement therapy in the treatment of AKI, which is frequently seen in patients with crush syndrome. Most can be treated with high volumes of intravenous fluid.

Rhabdomyolysis in COVID-19 Patients: A Retrospective Observational Study

Background The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide. Knowledge about the pathophysiology of the disease and its effect on multiple systems is growing. Kidney injury has been a topic of focus, and rhabdomyolysis is suspected to be one of the contributing mechanisms. However, information on rhabdomyolysis in patients affected by COVID-19 is limited. We aim to describe the incidence, clinical characteristics, and outcomes of patients hospitalized with COVID-19 who developed rhabdomyolysis. Materials and methods A retrospective observational cohort consisted of patients who were admitted and had an outcome between March 16 to May 27, 2020, inclusive of those dates at a single center in the Bronx, New York City. All consecutive inpatients with lab-confirmed COVID-19 were identified. Patients with peak total creatine kinase (CK) over 1,000 U/L were reviewed; 140 patients were included in the study. The main outcomes during hospitalization were new-onset renal replacement therapy and in-hospital mortality. Results The median age was 68 years (range: 21-93); 64% were males. The most common comorbidities were hypertension (73%), diabetes mellitus (47%), and chronic kidney disease (24%). Median CK on admission was 1,323 U/L (interquartile range [IQR]: 775 - 2,848). Median CK on discharge among survivors was 852 (IQR: 170 - 1,788). Median creatinine on admission was 1.78 mg/dL (IQR: 1.23 - 3.06). During hospitalization, 49 patients (35%) received invasive mechanical ventilation, 24 patients (17.1%) were treated with renal replacement therapy (RRT), and 66 (47.1%) died. Conclusions Rhabdomyolysis was a common finding among hospitalized patients with COVID-19 in our hospital in the Bronx. The incidence of new-onset renal replacement therapy and in-hospital mortality is higher in patients who develop rhabdomyolysis. McMahon score, rather than isolated creatine kinase levels, was a statistically significant predictor of new-onset RRT. Clinicians should maintain a high level of suspicion for rhabdomyolysis in COVID-19 patients throughout their admission and use validated scores like McMahon score to devise their treatment plan accordingly.