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Role of the Neutrophil-to-Lymphocyte Ratio at the Time of Arrival at the Emergency Room as a Predictor of Rhabdomyolysis in Severe Trauma Patients
Jin Chul Bae, Kyung Hoon Sun, Yong Jin Park
J Trauma Inj. 2020;33(2):96-103.   Published online June 17, 2020
DOI: https://doi.org/10.20408/jti.2020.018
  • 5,526 View
  • 95 Download
AbstractAbstract PDF
Purpose

In patients with trauma, rhabdomyolysis (RM) can lead to fatal complications resulting from muscle damage. Thus, RM must be immediately diagnosed and treated to prevent complications. Creatine kinase (CK) is the most sensitive marker for diagnosing RM. However, relying on CK tests may result in delayed treatment, as it takes approximately 1 hour to obtain CK blood test results. Hence, this study investigated whether the neutrophil-to-lymphocyte ratio (NLR) could predict RM at an earlier time point in patients with trauma, since NLR results can be obtained within 10 minutes.

Methods

This retrospective study included 130 patients with severe trauma who were admitted to the emergency room of a tertiary institution between January 2017 and April 2020. RM was defined as a CK level ≥1,000 U/L at the time of arrival. Patients with severe trauma were categorized into non-RM and RM groups, and their characteristics and blood test results were analyzed. Statistical analysis was performed using SPSS version 26.0 for Windows.

Results

Of the 130 patients with severe trauma, 50 presented with RM. In the multivariate analysis, the NLR (odds ratio [OR], 1.252; 95% confidence interval [CI], 1.130– 1.386), pH level (OR, 0.006; 95% CI, 0.000–0.198), presence of acute kidney injury (OR, 3.009; 95% CI, 1.140–7.941), and extremity Abbreviated Injury Scale score (OR, 1.819; 95% CI, 1.111–2.980) significantly differed between the non-RM and RM groups. A receiver operating characteristic analysis revealed that a cut-off NLR value of 3.64 was the best for predicting RM.

Conclusions

In patients with trauma, the NLR at the time of arrival at the hospital is a useful biochemical marker for predicting RM.

Summary
Early Predictive Values for Severe Rhabdomyolysis in Blunt Trauma
Jung Yun Park, Myoung Jun Kim, Jae Gil Lee
J Trauma Inj. 2019;32(1):26-31.   Published online March 31, 2019
DOI: https://doi.org/10.20408/jti.2018.029
  • 4,573 View
  • 126 Download
  • 2 Citations
AbstractAbstract PDF
Purpose

Rhabdomyolysis (RB) is a syndrome characterized by the decomposition of striated muscles and leakage of their contents into the bloodstream. Acute kidney injury (AKI) is the most significant and serious complication of RB and is a major cause of mortality in patients with RB. Severe RB (creatine kinase [CK] ≥5,000) has been associated with AKI. However, early prediction is difficult because CK can reach peak levels 1?3 days after the trauma. Hence, the aim of our study was to identify predictors of severe RB using initial patient information and parameters.

Methods

We retrospectively analyzed 1,023 blunt trauma patients admitted to a single tertiary hospital between August 2011 and March 2018. Patients with previously diagnosed chronic kidney disease were excluded from the study. RB and severe RB were defined as a CK level ≥1,000 U/L and ≥5,000 U/L, respectively. The diagnosis of AKI was based on RIFLE criteria.

Results

The overall incidence of RB and severe RB was 31.3% (n=320) and 6.2% (n=63), respectively. On multivariable analysis, male sex (odds ratio [OR] 3.78, 95% confidence interval [CI] 1.43 to 10.00), initial base excess (OR 0.85, 95% CI 0.80 to 0.90), initial CK (OR 2.07, 95% CI 1.67 to 2.57), and extremity abbreviated injury scale score (OR 1.78, 95% CI 1.39 to 2.29) were found to predict severe RB. The results of receiver operating characteristic analysis showed that the best cutoff value for the initial serum CK level predictive of severe RB was 1,494 U/L.

Conclusions

Male patients with severe extremity injuries, low base excess, and initial CK level >1,500 U/L should receive vigorous fluid resuscitation.

Summary

Citations

Citations to this article as recorded by  
  • Factors Associated with Acute Kidney Injury Occurrence and Prognosis in Rhabdomyolysis at the Emergency Department
    Jun Seok Seo, Inhwan Yeo, Changho Kim, Daeun Kim, Jeong-Hoon Lim, Kyoungtae Park, Jiwoo Jeong, Hojin Kwon, Yuna Cho, Sungyeon Park
    Medicina.2024; 60(1): 105.     CrossRef
  • Role of the Neutrophil-to-Lymphocyte Ratio at the Time of Arrival at the Emergency Room as a Predictor of Rhabdomyolysis in Severe Trauma Patients
    Jin Chul Bae, Kyung Hoon Sun, Yong Jin Park
    Journal of Trauma and Injury.2020; 33(2): 96.     CrossRef
Comparative Analysis between Spinning and Other Causes in Exercise-Induced Rhabdomyolysis
Do Won Shim, Sung Youl Hyun, Jae Hyug Woo, Jae Ho Jang, Jae Yeon Choi
J Trauma Inj. 2018;31(3):159-165.   Published online December 31, 2018
DOI: https://doi.org/10.20408/jti.2018.038
  • 3,054 View
  • 40 Download
  • 1 Citations
AbstractAbstract PDF
Purpose

Spinning-induced rhabdomyolysis (SIR) has been increasing in recent years and accounts for a large proportion of exercise-induced rhabdomyolysis (EIR). The purpose of this study was to compare the clinical features between SIR and non-spinning exercise-induced rhabdomyolysis (NSIR), and to analyze each of these clinical features.

Methods

A retrospective chart review was conducted on patients treated due to EIR from January 2006 to March 2018. Patients were divided into the SIR and NSIR groups, and their clinical factors, outcome, and blood chemistries were compared and analyzed.

Results

Sixty-two patients were enrolled in this study, with 23 (37.1%) and 39 (62.9%) patients categorized in the SIR and NSIR groups, respectively. The SIR group were mostly women (78.3% vs. 38.5%, p=0.002), more f requent EIR occurrence in the first exercise class (60.9% vs. 15.4%, p=0.001), and had most complaints of thigh pain (91.3% vs. 43.6%, p=0.001). The SIR group had a higher incidence rate despite its shorter exercise duration (90.5% vs. 62.9%, p=0.024), longer hospital stay (6.0 [4.5?7.0] vs. 5.0 [3.5?6.0] days, p=0.080), and higher rate of peak CPK (15,000 U/L or higher) (91.3% vs. 74.4%, p=0.182) compared to the NSIR group.

Conclusions

SIR occurs at a higher rate during the first exercise class in women compared to NSIR, and the incidence rate is higher in SIR than in NSIR despite its shorter exercise duration (less than 60 minutes). It is necessary to recognize these risks during spinning exercises and to perform these exercises sequentially and systematically.

Summary

Citations

Citations to this article as recorded by  
  • Clinical characteristics and outcomes of exertional rhabdomyolysis after indoor spinning: a systematic review
    Yoshio Masuda, Rachel Wam, Benjamin Paik, Clara Ngoh, Andrew MTL Choong, Jun Jie Ng
    The Physician and Sportsmedicine.2023; 51(4): 294.     CrossRef

J Trauma Inj : Journal of Trauma and Injury