Venous bicarbonate and creatine kinase as diagnostic and prognostic tools in the setting of acute traumatic rhabdomyolysis.

Abstract

BACKGROUND:

Myorenal or crush syndrome often develops following soft-tissue traumatic injury. It is a spectrum of disease that may result in severe renal dysfunction and kidney injury requiring renal replacement therapy.

OBJECTIVES:

To review a large cohort of patients with so-called myorenal or crush syndrome and assess the biochemical markers of venous bicarbonate and creatine kinase as predictors for the development of acute kidney injury (AKI).

METHODS:

All patients with myorenal syndrome who presented to Khayelitsha District Hospital, Cape Town, South Africa (SA), and Ngwelezana Hospital, Empangeni, KwaZulu-Natal, SA, between January and December 2017 were identified and reviewed.

RESULTS:

A total of 212 patients were included in the study. At both hospitals, 94% of the patients were male. Using the Pearson correlation coefficient, we compared creatinine kinase (CK) against serum creatinine. The mean CK level was 5 311.8 U/L and the mean creatinine level 133.457 μmol/L. The r-value was 0.2533. Although this is a technically positive correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000208. When comparing venous bicarbonate (HCO3) against creatinine, the mean HCO3 level was 22.296 mmol/L and the mean creatinine level 162.053 μmol/L. The r-value was -0.3468. Although this is a technically negative correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000013. The inverse ratio shown with HCO3 v. creatinine, although still a weak correlation, is significantly better in predicting an increase in creatinine compared with the weak positive correlation of CK v. creatinine.

CONCLUSIONS:

Although both venous HCO3 and CK showed a weak correlation with creatinine, the former performed significantly better in predicting AKI. In a resource-constrained system, we recommend that HCO3 be measured to assess patients with crush injury and that CK be regarded as a complementary modality.

• Authors: J J P Buitendag, M Q Patel, S Variawa, J Fichardt, B Mostert, A Goliath, D L Clarke, G V Oosthuizen
• Journal: South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (S Afr Med J) Vol. 111 Issue 4 Pg. 333-337 (Mar 31 2021) ISSN: 2078-5135 [Electronic] South Africa
• PMID: 33944766 (Publication Type: Journal Article)

Chemical References

• Bicarbonates
• Biomarkers
• Creatinine
• Creatine Kinase

Topics

• Acute Kidney Injury (diagnosis, etiology)
• Adult
• Bicarbonates (blood)
• Biomarkers (blood)
• Creatine Kinase (blood)
• Creatinine (blood)
• Crush Syndrome (blood, complications)
• Female
• Humans
• Male
• Prognosis
• Retrospective Studies
• Rhabdomyolysis (blood, diagnosis, etiology, therapy)
• Treatment Outcome