A risk prediction score for kidney failure or mortality in rhabdomyolysis
The Article: McMahon GM1, Zeng X, Waikar SS. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med. 2013 Oct 28;173(19):1821-8.
The Idea: Whether renal replacement therapy and mortality can be predicted from those patients presenting with rhabdomyolosis. The Study: Two center study in Boston, MA of admitted patients with elevated CK. Prediction score was developed after review of about 1,000 patients at MGH and then tested on a cohort at Brigham and Women’s Hospital. Composite outcome of renal replacement therapy (RRT) and mortality used. The Findings: Sepsis, compartment syndrome and cardiac arrest were the most associated w RRT and mortality. Patients were not at an increased risk until CK was elevated above 40,000. Authors note that given low risk of exercise and seizure induced rhabdomyolysis, these may be discharged from ED without admission. The takeaway: Sick patients with elevated CK have worse outcomes. However, treating mild cases of rhabdomyolysis with hydration in the ED may be discharged without admission for low risk groups. If I were to have a young healthy individual present w elevated CK after exercise and I could demonstrate that CK was improving after IVF hydration, I may discharge this patient from the ED, rather than admitting in the future.