Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients
Short- and long-term renal outcomes following severe rhabdomyolysis: a French multicenter retrospective study of 387 patients
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DOI：
10.1186/s13613-020-0645-1
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发表时间：
2020-03-02
影响因子：
8.1
通讯作者：
Faguer, Stanislas
中科院分区：
文献类型：
--
作者：
Candela, Nelly;Silva, Stein;Faguer, Stanislas
背景横纹肌溶解症是一种危及生命的疾病，可导致严重的高钾血症、急性肾损伤（阿基）和低血容量性休克。阿基和急慢性肾病（CKD）转变的预测因素仍缺乏描述。方法对387例CPK > 5000 U/L的重症横纹肌溶解症患者进行多中心回顾性研究。主要终点是严重阿基的发展，定义为KDIGO分类的2期或3期。次要终点包括阿基向CKD转变的发生率。结果387例患者中，315例（81.4%）发生阿基，其中3期阿基171例（44.1%），需要RRT的103例（26.6%）。2-3期阿基与入院时的血清磷酸盐、钾和碳酸氢盐以及肌红蛋白超过8000 U/L和机械通气需求密切相关。42例患者（10.8%）在第28天前死亡。在横纹肌溶解症之前和之后3个月具有可用eGFR值的80名患者中，eGFR降低（23名患者大于20 mL/min/1.73 m（2）; 28.8%）与阿基的严重程度和入院时血清肌红蛋白水平> 8000 U/L相关。结论重症横纹肌溶解症可导致重症急性阿基。机械通气和横纹肌溶解的严重程度（包括肌红蛋白水平）与2-3阿基的风险相关。长期肾功能下降与入院时血清肌红蛋白相关。
Background Rhabdomyolysis is a life-threatening disease that can lead to severe hyperkalemia, acute kidney injury (AKI) and hypovolemic shock. The predictive factors of AKI and acute to chronic kidney disease (CKD) transition remain poorly described. Methods This multicenter retrospective study enrolled 387 patients with severe rhabdomyolysis (CPK > 5000 U/L). Primary end-point was the development of severe AKI, defined as stage 2 or 3 of KDIGO classification. Secondary end-points included the incidence of AKI to CKD transition. Results Among the 387 patients, 315 (81.4%) developed AKI, including 171 (44.1%) with stage 3 AKI and 103 (26.6%) requiring RRT. Stage 2-3 AKI was strongly correlated with serum phosphate, potassium and bicarbonate at admission, as well as myoglobin over 8000 U/L and the need for mechanical ventilation. 42 patients (10.8%) died before day 28. In the 80 patients with available eGFR values both before and 3 months after the rhabdomyolysis, the decrease in eGFR (greater than 20 mL/min/1.73 m(2) in 23 patients; 28.8%) was correlated to the severity of the AKI and serum myoglobin levels > 8000 U/L at admission. Conclusions Severe rhabdomyolysis leads to AKI in most patients admitted to an ICU. Mechanical ventilation and severity of the rhabdomyolysis, including myoglobin level, are associated with the risk of stage 2-3 AKI. The long-term renal decline is correlated to serum myoglobin at admission.