Subject(s)
Acute Kidney Injury/etiology , Coronavirus Infections/complications , Pneumonia, Viral/complications , Rhabdomyolysis/etiology , Acute Kidney Injury/blood , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Creatine Kinase/blood , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Renal Dialysis/methods , Rhabdomyolysis/blood , Rhabdomyolysis/diagnosis , SARS-CoV-2ABSTRACT
BACKGROUND: Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically ill COVID-19 patients. MATERIALS AND METHODS: Data for all critically ill adult patients (≥18 years old) admitted to the ICU at a large academic medical center with confirmed COVID-19 between March 13, 2020 and April 18, 2020 were prospectively collected. Patients with serum creatine kinase (CK) concentrations greater than 1000 U/L were diagnosed with rhabdomyolysis. Patients were further stratified as having moderate (serum CK concentration 1000-4999 U/L) or severe (serum CK concentration ≥5000 U/L) rhabdomyolysis. Univariate and multivariate analyses were performed to identify outcomes and variables associated with the development of rhabdomyolysis. RESULTS: Of 235 critically ill COVID-19 patients, 114 (48.5%) met diagnostic criteria for rhabdomyolysis. Patients with rhabdomyolysis more often required mechanical ventilation (P < 0.001), prone positioning (P < 0.001), pharmacological paralysis (P < 0.001), renal replacement therapy (P = 0.010), and extracorporeal membrane oxygenation (ECMO) (P = 0.025). They also had longer median ICU length of stay (LOS) (P < 0.001) and hospital LOS (P < 0.001). No difference in mortality was observed. Male sex, patients with morbid obesity, SOFA score, and prone positioning were independently associated with rhabdomyolysis. CONCLUSIONS: Nearly half of critically ill COVID-19 patients in our cohort met diagnostic criteria for rhabdomyolysis. Male sex, morbid obesity, SOFA score, and prone position were independently associated with rhabdomyolysis.
Subject(s)
COVID-19/complications , Obesity, Morbid/epidemiology , Rhabdomyolysis/epidemiology , Aged , Body Mass Index , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Comorbidity , Creatine Kinase/blood , Critical Illness , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Obesity, Morbid/complications , Obesity, Morbid/diagnosis , Organ Dysfunction Scores , Prone Position , Prospective Studies , Rhabdomyolysis/blood , Rhabdomyolysis/diagnosis , Rhabdomyolysis/etiology , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , Sex FactorsABSTRACT
The novel SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) is now known to cause acute respiratory distress, cytokine storm, and coagulopathy. Multiple other manifestations have been published in recent literature. Rhabdomyolysis is a syndrome of muscle damage, with release of intracellular contents into circulation. It is characterized by marked elevations of creatinine kinase levels and myoglobinuria. In this article, we describe a series of 5 cases who were admitted with COVID-19 pneumonia and had severe muscle injury, as demonstrated by significant elevation (>5 times upper limit of normal) of creatinine kinase levels likely secondary to SARS-CoV-2 virus. The median age for these patients was 65 years, and most of them suffered from diabetes and hyperlipidemia. All patients were hypertensive males. Four out of 5 patients had preserved kidney function at baseline and were chronic kidney disease (CKD) stage 2 or better. However, most of them suffered significant kidney injury and at the time of discharge one patient was CKD stage 2 or better, 2 were CKD stage 3 or worse, and 2 patients had renal failure and died due to complications of SARS-CoV-2 infection.
Subject(s)
COVID-19/complications , Rhabdomyolysis/virology , Aged , COVID-19/therapy , Creatine Kinase/blood , Diabetes Mellitus, Type 2/complications , Hospitalization , Humans , Hypertension/complications , Male , Middle Aged , Renal Insufficiency, Chronic/complications , Renal Insufficiency, Chronic/physiopathology , Rhabdomyolysis/blood , SARS-CoV-2ABSTRACT
COVID-19 is the illness caused by infection with the novel coronavirus SARS-CoV-2. Although myalgia is common in adults, it has not been noted as a common symptom in children. There have been a few reported cases of COVID-19-associated rhabdomyolysis in adults. This case report describes a 16-year-old boy who presented with fever, myalgias, mild shortness of breath with exertion, and dark-colored urine. COVID-19 PCR was positive. His initial creatinine kinase (CK) level was 427,656 U/L. Serum creatinine was normal for age. He was treated with isotonic intravenous fluids containing sodium bicarbonate to maintain urine output of 100-200 mL/h and urine pH > 7.0. His serum creatinine remained normal throughout the hospital stay and he was discharged on hospital day 12 with a CK of 6526 U/L. To our knowledge, no pediatric cases of COVID-19-associated rhabdomyolysis have been previously reported. Adult cases of rhabdomyolysis have been reported and a few reports have noted patients with elevated CK levels without rhabdomyolysis. Given this pediatric case of COVID-19-associated rhabdomyolysis, pediatric clinicians should be aware of this complication and manage fluids appropriately in order to prevent acute kidney injury.