The Investigation On The Aetiology And Clinical Significance Of Rhabdomyolysis In Critically Illness

Objective:Rhabdomyolysis (RM) is a syndrome which is associated with a wide variety of traumatic and non-traumatic diseases, and can result in renal impairment and multiple-organ dysfunction. Till now, there are few studies on RM in critically ill patients, and it isn’t clear about the epidemiology of RM and the effects of RM on prognostic in critically ill patients. The purpose of this study is to explore the aetiology and possible mechanism due to RM, furthermore to determinate the role of RM on organ function and outcome in critically ill patients.Methods:We recruited the105consecutive admission patients in ICU in this prospective study. According to our diagnostic criteria of RM, all the patients were divided into2groups:RM goups (CK≥2000U/L,21patients); and non-RM group (CK<2000U/L,84patients). The reasons of hospitalization were analyzed in all the patients. The clinical characteristics, biochemical parameters and illness severity scores of RM and non-RM groups were compared by Mann-Whitney test. Through the Pearson’s correlation analysis, the relationships between CK and the clinical characteristics, biochemical parameters and illness severity scores were determinated. Using binary logistic regression model, the contributing factors for CK increase were identified. The correlation between renal function and CK level was analyzed by Chi square test.Results:①In this study, RM was occurred in20%critically ill patients. The most important cause of RM is trauma, other causes include infection, hypoxic-ischemic encephalopathy (HIE), heat stroke, disturbance of consciousness.②Myoglobin (MYO), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and glasgow coma score (GCS) in RM group were significantly higher than non-RM group (p<0.01); creatine kinase-MB (CK-MB), hematocrit (Hct), procalcitonin (PCT) and artial pressure of carbon dioxide (PaCO2) in RM group were significantly higher than non-RM group (p<0.05); the age and chronic medical history in non-RM group are significantly higher than RM group (p<0.01).③CK was positively correlated with CK-MB, MYO, ALT, AST and LDH (p<0.01); CK was correlated with mechanical ventilation, cardiac troponin Ⅰ (CTnI), PaCO2and sequential organ failure assessment score (SOFA)(p<0.05) and negatively correlated with age, chronic medical history and GCS score (p<0.05).④MYO and PaCO2were risk factors related to RM, on the contrary age is protective factor for RM in this study.⑤The Chi square test has shown that significant difference in different CK groups and the proportions of renal impairment patients is significantly higher in higher CK group. CK level is also correlated to SOFA score.Conclusion:①In this study, it is a high incidence (20%) of RM was observed in critically ill patients. A variety of aetiologies can induce RM in critically ill patients; among them, trauma and infection are the most common causes.②The possible mechanism inducing RM is possible associated with serious infection, dehydration, disturbance of consciousness, respiratory failure, carbon dioxide retention and so on.③RM could be associated with the renal impairment and organic dysfunctions in this study.