Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 21 , ISSUE 12 ( 2017 ) > List of Articles


Predictive value of serum myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis

Nithin Raju, Shoma Rao, J. Joel, Gijoe Jacob, Arun Anil, S. Gowri

Keywords : Acute kidney injury, crush protocol, myoglobin, rhabdomyolysis

Citation Information : Raju N, Rao S, Joel J, Jacob G, Anil A, Gowri S. Predictive value of serum myoglobin and creatine phosphokinase for development of acute kidney injury in traumatic rhabdomyolysis. Indian J Crit Care Med 2017; 21 (12):852-856.

DOI: 10.4103/ijccm.IJCCM_186_17

License: CC BY-ND 3.0

Published Online: 01-12-2017

Copyright Statement:  Copyright © 2017; The Author(s).


Introduction: Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM. Methodology: A prospective observational study of 90 patients was admitted to the surgical Intensive Care Unit/high dependency unit of a tertiary hospital with traumatic RM whose serum CPK >5000 U/L. Along with standard treatment including intravascular volume optimization and hemodynamic stabilization, they were treated with “crush protocol.” Daily/twice a day, serum CPK and myoglobin were estimated. Categorical data are expressed as frequency and percentage, and the continuous variables are presented as mean (standard deviation) or median (interquartile range) based on normality. Other statistical analyses were done using the Chi-square test, independent t-test, and rank sum test based on normality. Results: Fourteen out of 90 patients developed AKI and one patient required renal replacement therapy. CPK value of >12,000 U/l was identified to have 64% sensitivity and 56% specificity for developing AKI whereas serum myoglobin value of >5000 ng/ml was identified to have 78% sensitivity and 77% specificity for developing AKI. Conclusion: Following traumatic RM, in patients on “crush protocol,” serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI.

PDF Share
  1. Petejova N, Martinek A. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: A critical review. Crit Care 2014;18:224.
  2. Vanholder R, Sever MS, Erek E, Lameire N. Rhabdomyolysis. J Am Soc Nephrol 2000;11:1553-61.
  3. Huerta-Alardín AL, Varon J, Marik PE. Bench-to-bedside review: Rhabdomyolysis – An overview for clinicians. Crit Care 2005;9:158-69.
  4. Zimmerman JL, Shen MC. Rhabdomyolysis. Chest 2013;144:1058-65.
  5. Melli G, Chaudhry V, Cornblath DR. Rhabdomyolysis: An evaluation of 475 hospitalized patients. Medicine (Baltimore) 2005;84:377-85.
  6. Khan FY. Rhabdomyolysis: A review of the literature. Neth J Med 2009;67:272-83.
  7. Mikkelsen TS, Toft P. Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Acta Anaesthesiol Scand 2005;49:859-64.
  8. Beetham R. Biochemical investigation of suspected rhabdomyolysis. Ann Clin Biochem 2000;37(Pt 5):581-7.
  9. Octura JE, Lee KJ, Cho HW, Vega RS, Choi J, Park JW, et al. Elevation of blood creatine kinase and selected blood parameters after exercise in thoroughbred racehorses (Equus caballus L.). J Res Agric Anim Sci 2014;2:7-13.
  10. Zhang MH. Rhabdomyolosis and its pathogenesis. World J Emerg Med 2012;3:11-5.
  11. Stone MJ, Waterman MR, Harimoto D, Murray G, Willson N, Platt MR, et al. Serum myoglobin level as diagnostic test in patients with acute myocardial infarction. Br Heart J 1977;39:375-80.
  12. Sever MS, Vanholder R, Lameire N. Management of crush-related injuries after disasters. N Engl J Med 2006;354:1052-63.
  13. Kuzmanovska B, Cvetkovska E, Kuzmanovski I, Jankulovski N, Shosholcheva M, Kartalov A, et al. Rhabdomyolysis in critically ill surgical patients. Med Arch 2016;70:308-10.
  14. Premru V, Kovač J, Ponikvar R. Use of myoglobin as a marker and predictor in myoglobinuric acute kidney injury. Ther Apher Dial 2013;17:391-5.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.