Acute Rhabdomyolysis in the Pediatric Intensive Care Unit: Etiology, Clinical Features, Treatment, and Prognosis

Abstract

Objective:This study was designed to identify the underlying etiology, evaluate the treatment methods, and determine the incidence of acute kidney injury (AKI), and to establish the predictive laboratory values for kidney failure and the factors associated with mortality in critically ill children with a diagnosis of rhabdomyolysis and high creatine kinase (CK) levels.Method:Twenty-three patients who were diagnosed with acute rhabdomyolysis in the first 48 hours in the pediatric intensive care unit between January 2011 and January 2021 and whose CK levels were found to be ≥50.000 IU/L in follow-up were included in the study. The ages of the patients ranged from 1 month to 18 years. Patients with muscular diseases, postoperative patients, and chronic renal failure patients were not included.Results:The median age of the patients was 71 months (41-141 months). The three most common causes were infection (n=11, 47%), intoxication (n=5, 21.7%), and metabolic disease (n=4, 17.3%). While the mean CK value of the patients at admission was 53.570±32.37 IU/L, the peak CK value was 88.936 IU/L (60.558-122.962). Eleven patients (47.8%) developed AKI. Continuous renal replacement therapy (CRRT) was performed for six patients (26%). Between those who developed kidney failure and those who did not, the differences between the pediatric risk of mortality scores, blood urea nitrogen, creatinine, uric acid, and calcium measured during hospitalization were significant, while the difference in CK values was not. The incidence of kidney failure was significantly higher in patients who needed mechanical ventilation, inotrope administration, or extracorporeal therapy and in patients with three or more organ failures. Mortality was significantly higher in patients who needed inotropes or CRRT, had three or more organ failures, or developed stage 3 kidney failure. End-stage kidney failure was not observed in any of the surviving patients. Four patients (17.4%) included in the study died. The relationship between mortality and peak CK elevation was not significant.Conclusion:The prognosis of rhabdomyolysis is related to the underlying etiology and comorbid conditions. Early aggressive fluid therapy positively affects the course of the disease.

Keywords

• acute kidney injury
• creatinine kinase
• mortality
• pediatric intensive care
• prognosis
• rhabdomyolysis