Zhongguo linchuang yanjiu (Jun 2024)
Predictive indicators of acute kidney injury caused by exertional rhabdomyolysis
Abstract
Objective To investigate the characteristics of exertional rhabdomyolysis (ERB) and the predictive value of creatine kinase (CK), myoglobin/creatine kinase (Mb/CK) ratio and other indicators for ERB patients with acute renal injury (AKI). Methods The clinical data of 154 patients with ERB admitted to the Affiliated Hospital of Qingdao University from January 2013 to September 2022 were retrospectively analyzed. The patients were divided into AKI group (n=35) and non-AKI group (n=119) according to whether AKI was combined. Creatinine, CK and other laboratory indicators were collected. Univariate and multivariate logistic regression models were used to analyze the risk factors for AKI in ERB patients. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of related indicators, and the correlation between each indicator and serum creatinine was analyzed by Spearman correlation analysis. Results The main clinical manifestations of 154 ERB patients were muscle pain (140 cases), limb weakness (69 cases), and dark brown urine (36 cases). The levels of CK, creatine kinase isoenzyme (CK-MB), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in non-AKI group were significantly higher than those in AKI group (P＜0.05). The levels of creatinine, lactate dehydrogenase (LDH), cystatin C, Mb/CK and creatinine/cystatin C in AKI group were higher than those in non-AKI group, and the differences were statistically significant (P<0.05). In ERB patients, Mb/CK (r=0.297, P<0.001), cystatin C (r=0.419, P<0.001) were positively correlated with serum creatinine, and CK (r=-0.191, P=0.018), CK-MB (r=-0.200, P=0.013), ALT (r=-0.271, P=0.001), AST (r=-0.308, P<0.001) were negatively correlated with serum creatinine. Multivariate logistic regression analysis showed that LDH ［1.001 (1.001-1.001)］, Mb/CK ［1.010 (1.006-1.014)］, cystatin C ［1.031 (1.011-1.050)］, Mb/creatinine ［1.007 (1.001-1.013)］, creatinine/cystatin C ［1.008 (1.000-1.015)］ were independent risk factors for AKI in ERB patients (P＜0.05). ROC curve analysis showed creatinine (AUC＝0.753), Mb/CK (AUC＝0.989), LDH (AUC＝0.800), CK (AUC＝0.815), ALT (AUC＝0.667), AST (AUC＝0.694), cystatin C (AUC＝0.673), creatinine/cystatin C (AUC＝0.702), and CK-MB (AUC＝0.752) had certain value in predicting whether patients with ERB had AKI (P<0.05), and Mb/CK had the best predictive efficacy. Conclusion LDH, Mb/CK, Cystatin C, Mb/creatinine, and creatinine/cystatin C are independent risk factors for ERB patients with AKI. Creatinine, LDH, CK, ALT, AST, CK-MB, cystatin C, Mb/CK, and creatinine/cystatin C can be used as evaluation indicators for predicting the risk of ERB patients with AKI. Among them, Mb/CK and creatinine/cystatin C are new predictive indicators.
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