Impact of raising serum myoglobin on resuscitation of trauma patients with high injury severity score (ISS)

Abstract

Introduction: Recent studies recommend limiting the amount of crystalloid perfused during resuscitation for trauma patients. Severely injured patients sustain extensive muscle damage with subsequent high serum myoglobin levels precipitating acute renal injury if not treated immediately. To timely identify patients at risk of acute renal injury, we proposed determining the strength of the correlation between the American College of Surgeons–defined injury severity score with serum and urine myoglobin level in the early hours of arrival to the emergency department to determine the patient at higher risk of raising serum myoglobin level and subsequent renal injury. Method: A retrospective analysis was conducted at a 400-bed community teaching hospital with a level 2 trauma section and annual admission of 750–800 patients using the data in the trauma registry (2010–2017). Patients with an injury severity score of 15 or above were selected, and Student t test and Pearson correlation 2-tailed analysis were used to identify the relationship with serum myoglobin. Result: There were 306 patients total, with 200 men (70.3%) and 106 women (29.7%) and a mean age of 60.64 (SD = 23.6) (range 18–96) years. The mean injury severity score was 22.3 (SD = 8.5) (range 16–75). The median level of serum myoglobin in the first 24 hours of admission was 848.56 ng/mL (range 22–11,197). There was a strong and significant correlation between the 2 variables (r = 0.397, P < .0001). Conclusion: The appearance of urine myoglobin with serum level of 39 ng/mL suggests that with higher injury severity score, the potential for acute kidney injury is likely and should be addressed early in the patient management.