Dynamics of biochemical markers of rhabdomyolysis in multiple trauma

Abstract

Background. Traumatic injuries often lead to rhabdomyolysis — the destruction of muscle tissue, which causes a lea­kage of intracellular myocytes into the bloodstream. In addition to the crush syndrome, the causes of traumatic rhabdomyolysis may be direct muscle damage in massive bone and soft tissue injuries, muscle hypoxia in crush syndrome, systemic inflammatory response syndrome or hypovolemic shock, positional compression syndrome in long surgeries, aggressive and prolonged soft tissue retraction during surgeries, multiple and complex surgical interventions and prolonged use of tourniquets. The most important biochemical markers of rhabdomyolysis are creatine kinase and myoglobin. The purpose of our study was to analyze the dynamics of biochemical markers of rhabdomyolysis in victims of peacetime and combat polytrauma. Materials and methods. One hundred and twenty-one multiple trauma victims were examined. We studied the need for diuresis stimulation and renal replacement therapy, levels of urea and blood creatinine, total creatine kinase (CK), CK-MB and serum myoglobin. Results. The content of total CK over 5,000 IU/l on admission correlated with morta­lity. In survivors, total CK level began to decrease 24 hours after the injury and on day 14 exceeded the norm by only 2 times. In the non-survivors, CK levels remained at baseline or increased. CK-MB levels were not associated with mortality, but long-term and sustained increase was observed in victims with severe combat injuries, massive transfusions, and the need for renal replacement therapy. Baseline myoglobin levels did not correlate with subsequent mortality, but in survivors, serum myoglobin levels declined rapidly, while in the non-survivors, they remained steady or re-increased after some reduction. Levels of rhabdomyolysis mar­kers were clearly associated with renal function and the need for diuresis stimulation and/or renal replacement therapy, and for CK and CK-MB, this correlation was formed within 6 hours after admission, for myoglobin — from day 3. The composition of blood replacement also affected the markers of rhabdomyolysis. The volume of synthetic colloids, fresh frozen plasma, and erythrocytes administered on the first day was directly related to the levels of CK, CK-MB, and myoglobin at all stages of the study. Conclusions. Thus, multiple trauma with massive blood loss is accompanied by rhabdomyolysis the severity of which depends on the injury severity and is a predictor of acute kidney injury and mortality. The absence of a decrease in the levels of CK and myoglobin despite intensive care is an unfavorable prognostic criterion. In patients with severe multiple trauma, the levels of CK, CK-MB and myoglobin should be studied in dynamics.

Keywords

• multiple trauma
• rhabdomyolysis
• creatine kinase
• myoglobine
• acute kidney injury