ABSTRACT
Exercise-induced rhabdomyolysis (EIR) is an uncommon cause of severe rhabdomyolysis and a very rare cause of acute kidney injury (AKI). A prospective observational study of 25 patients diagnosed with EIR was conducted in a multispecialty hospital in Dubai, from 2009 to 2015. Five out of 25 patients experienced AKI necessitating temporary renal replacement therapy. The initial presentation, biochemical parameters, and clinical course of patients were monitored, to understand epidemiology and risk factors for the development of AKI. There was male preponderance (4 out of 5 patients), higher rate of systemic symptoms (all 5 patients) versus 60% in NRAKI), oligo-anuria (all 5 patients), compartment syndrome (3 out \of 5) and severe dehydration seen in patients with RAKI group. On laboratory evaluation, there was higher rise in creatinine kinase (CK) enzyme, serum and urine myoglobin levels impaired renal function on presentation, hyperuricemia, high D-dimer level, PCV of more than 55%, found to be associated with RAKI as compared to NRAKI group. Hematuria by positive urine dipstick with absent red blood cells on urinalysis, is an insensitive tool as was present in only 62% and 43% of RAKI and NRAKI groups, respectively. It was also observed that delayed pesentation for medical care, metabolic acidosis, were commonly associated with AKI. All patients with RAKI required RRT for a comparable period of time (3-4 weeks). In all of them, no deterioration or relapse reported on follow-up of 3 months.
ABSTRACT
BACKGROUND: The aim of this study was to assess the performance of Acute Physiology and Chronic Health Evaluation (APACHE) IV, Simplified Acute Physiology Score (SAPS) III, and Mortality Probability Model (MPM) III0 and compare these systems to more widely validated prognosis prediction tools like APACHE II, III, SAPS II, MPM II0 and Sequential Organ Failure Assessment (SOFA) score. METHODS: The study provided a retrospective analysis of data for all consecutive patients admitted to a medical ICU over a 15-month period. Data related to patient demographics, and that necessary to compute various scores were recorded. Calibration was assessed by calculating Lemeshow-Hosmer goodness-of-fit test. Discrimination was evaluated by calculating the area under curves (AUC). Primary outcome measure was Intensive Care Unit mortality. RESULTS: Mortality predicted by APACHE IV score was closest to that of actual mortality with a SMR of 0.868 followed by that of MPM III0 (0.794) and SAPS III (0.763) scores. APACHE III (χ2=3.674), with P=0.885 had the best calibration followed by APACHE II (χ2=7.959; P=0.438) and SOFA scores (χ2=8.369; P=0.301). All scores had good efficacy and even though there was no significant difference between AUCs of various scores, MPM III0 (0.947) performed the best followed by APACHE IV (0.928) and MPM II0 (0.928). CONCLUSION: Overall, the newer scoring systems performed better than their older counterparts and were more accurate. Nevertheless, the difference in efficacy was not statistically significant and the choice of scoring system may depend on the ease of use and local preferences.
