Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey

Objective. To evaluate the risk factors for the development of acute renal failure (ARF) in severe rhabdomyolysis. Design. Observational historical cohort study. Setting. General intensive care unit of a university hospital. Patients. Twenty-six patients with severe rhabdomyolysis, who were admitted between July 1996 and July 2001. Measurements and results. Clinical and laboratory data were reviewed and groups were stratified according to presence or absence of acute renal failure. The underlying cause of rhabdomyolysis was ischemia by vascular obstruction (50%), crush injury by trauma (23%), sepsis (11.5%), heatstroke/hyperthermia (11.5%) and hyponatremia in a single patient. Mean creatine kinase (CK) level was 38,351+/-35,354 U/l on admission and rose further in all patients (mean: 59,747+/-67,514 U/l). Renal failure developed in 17 patients (65%). Serum CK levels correlated with onset of ARF, as these patients had significantly higher admission and peak serum CK concentrations. Patients with ARF had a higher mortality (59% vs 22%). Conclusion. In our cohort of patients with severe rhabdomyolysis the level of serum CK predicted the development of ARF. Although our results suggest that series of CK determination might be beneficial for the evaluation of the effect of therapy, the value of CK determination as a prognostic tool is limited, given the wide range of CK levels.