A risk prediction score for kidney failure or mortality in rhabdomyolysis.
A risk prediction score for kidney failure or mortality in rhabdomyolysis.
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DOI：
10.1001/jamainternmed.2013.9774
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发表时间：
2013-10-28
影响因子：
39
通讯作者：
Waikar, Sushrut S.
中科院分区：
文献类型：
--
作者：
McMahon, Gearoid M.;Zeng, Xiaoxi;Waikar, Sushrut S.
横纹肌溶解症的严重程度范围从肌酸磷酸激酶水平的无症状升高到以需要血液透析或连续性肾脏替代治疗（RRT）的重度急性肾损伤为特征的危及生命的疾病。开发风险预测工具，以识别RRT或住院死亡风险最大的患者。对2000年1月1日至2011年3月31日期间在马萨诸塞州波士顿的2家大型教学医院住院的2371例患者进行的回顾性队列研究，这些患者在入院3天内肌酸磷酸激酶水平超过5000 U/L。推导队列包括来自马萨诸塞州总医院的1397例患者，验证队列包括来自Brigham and Women's Hospital的974例患者。RRT或住院死亡率的复合终点。推导和验证队列之间横纹肌溶解症的原因和结局相似。总体而言，19.0%的患者发生复合结局（8.0%需要RRT，14.1%在住院期间死亡）。复合结局发生率最高的是筋膜室综合征（41.2%）、脓毒症（39.3%）和心脏骤停后（58.5%）。发病率最低的是肌炎（1.7%）、运动（3.2%）和癫痫发作（6.0%）。复合结果的独立预测因素为年龄、女性、横纹肌溶解症的病因、初始肌酐、肌酸磷酸激酶、磷酸盐、钙和碳酸氢盐。我们在推导队列中根据这些变量开发了风险预测评分，随后将其应用于验证队列。推导队列中预测模型的C统计量为0.82（95% CI，0.80-0.85），验证队列中为0.83（0.80-0.86）。Hosmer-Lemeshow P值分别为0.14和0.28。在验证队列中，风险评分最低（<5）的患者中，2.3%死亡或需要RRT。在风险评分最高（>10）的患者中，61.2%死亡或需要RRT。横纹肌溶解症的结局因临床情况而异。横纹肌溶解症患者的RRT或院内死亡风险可使用入院时常用的人口统计学、临床和实验室变量进行估计。
Rhabdomyolysis ranges in severity from asymptomatic elevations in creatine phosphokinase levels to a life-threatening disorder characterized by severe acute kidney injury requiring hemodialysis or continuous renal replacement therapy (RRT). To develop a risk prediction tool to identify patients at greatest risk of RRT or in-hospital mortality. Retrospective cohort study of 2371 patients admitted between January 1, 2000, and March 31, 2011, to 2 large teaching hospitals in Boston, Massachusetts, with creatine phosphokinase levels in excess of 5000 U/L within 3 days of admission. The derivation cohort consisted of 1397 patients from Massachusetts General Hospital, and the validation cohort comprised 974 patients from Brigham and Women’s Hospital. The composite of RRT or in-hospital mortality. The causes and outcomes of rhabdomyolysis were similar between the derivation and validation cohorts. In total, the composite outcome occurred in 19.0% of patients (8.0% required RRT and 14.1% died during hospitalization). The highest rates of the composite outcome were from compartment syndrome (41.2%), sepsis (39.3%), and following cardiac arrest (58.5%). The lowest rates were from myositis (1.7%), exercise (3.2%), and seizures (6.0%). The independent predictors of the composite outcome were age, female sex, cause of rhabdomyolysis, and values of initial creatinine, creatine phosphokinase, phosphate, calcium, and bicarbonate. We developed a risk-prediction score from these variables in the derivation cohort and subsequently applied it in the validation cohort. The C statistic for the prediction model was 0.82 (95% CI, 0.80–0.85) in the derivation cohort and 0.83 (0.80–0.86) in the validation cohort. The Hosmer-Lemeshow P values were .14 and .28, respectively. In the validation cohort, among the patients with the lowest risk score (<5), 2.3% died or needed RRT. Among the patients with the highest risk score (>10), 61.2% died or needed RRT. Outcomes from rhabdomyolysis vary widely depending on the clinical context. The risk of RRT or in-hospital mortality in patients with rhabdomyolysis can be estimated using commonly available demographic, clinical, and laboratory variables on admission.
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影响因子：
3.3
作者：
Hubal, Monica J.;Devaney, Joseph M.;Clarkson, Priscilla M.
通讯作者：
Clarkson, Priscilla M.
DOI：
10.1249/01.mss.0000210192.49210.fc
发表时间：
2006-04-01
期刊：
MEDICINE AND SCIENCE IN SPORTS AND EXERCISE
影响因子：
--
作者：
Clarkson, PM;Kearns, AK;Thompson, PD
通讯作者：
Thompson, PD
影响因子：
1.4
作者：
Hoffman, Martin D.;Ingwerson, Julie L.;Stuempfle, Kristin J.
通讯作者：
Stuempfle, Kristin J.
影响因子：
120.7
作者：
Wijeysundera, Duminda N.;Karkouti, Keyvan;Beattie, W. Scott
通讯作者：
Beattie, W. Scott
影响因子：
38.9
作者：
Bota, DP;Melot, C;Vincent, JL
通讯作者：
Vincent, JL