Abstract
Objective: This study was designed to identify the underlying etiology, evaluate the treatment methods, and determine the incidence of acute kidney injury (AKI), and to establish the predictive laboratory values for kidney failure and the factors associated with mortality in critically ill children with a diagnosis of rhabdomyolysis and high creatine kinase (CK) levels.
Materials and Methods: Twenty-three patients who were diagnosed with acute rhabdomyolysis in the first 48 hours in the pediatric intensive care unit between January 2011 and January 2021 and whose CK levels were found to be ≥50.000 IU/L in follow-up were included in the study. The ages of the patients ranged between 1 month and 18 years. Patients with muscular diseases, postoperative patients, and chronic renal failure patients were not included.
Results: The median age of the patients was 71 months (41-141 months). The three most common causes were infection (n=11, 47%), intoxication (n=5, 21.7%), and metabolic disease (n=4, 17.3%). While the mean CK value of the patients at admission was 53.570±32.371IU/L, the peak CK value was 88.936 IU/L (60.558-122.962). Eleven patients (47.8%) developed AKI. Continuous renal replacement therapy (CRRT) was performed for six patients (26%). Between those who developed kidney failure and those who did not, the differences between the Pediatric Risk of Mortality (PRISM) scores, blood urea nitrogen, creatinine, uric acid, and calcium measured during hospitalization were significant, while the difference in CK values was not.
The incidence of kidney failure was significantly higher in patients who needed mechanical ventilation, inotrope administration, or extracorporeal therapy and in patients with three or more organ failures. Mortality was significantly higher in patients who needed inotropes or CRRT, had three or more organ failures, or developed stage 3 kidney failure. End-stage kidney failure was not observed in any of the surviving patients. Four patients (17.4%) included in the study died. The relationship between mortality and peak CK elevation was not significant.
Conclusion: The prognosis of rhabdomyolysis is related to the underlying etiology and comorbid conditions. Early aggressive fluid therapy positively affects the course of the disease.
Keywords: Pediatric intensive care, Rhabdomyolysis, Creatinine kinase, Acute kidney injury, Prognosis, Mortality
Çocuk Yoğun Bakım Ünitesinde Akut Rabdomiyoliz: Etiyoloji, Klinik Özellikler, Tedavi ve Prognoz
Öz
Amaç: Rabdomiyoliz tanısı konulan ve kreatin kinaz (CK) düzeyi yüksek olan kritik çocuk hastalarda, altta yatan etiyolojiyi saptamak, tedavi yöntemlerini değerlendirmek, akut böbrek yetmezliği (ABY) görülme sıklığını ve böbrek yetmezliği için prediktif laboratuvar değerlerini saptamak ve mortalite ile ilişkili faktörleri belirlemektir.
Yöntem ve Gereçler: Çalışmaya Ocak 2011 – Ocak 2021 arasında çocuk yoğun bakım ünitesinde ilk 48 saatte akut rabdomiyoliz tanısı konulan ve izlemde CK düzeyi 50.000 IU/L ve üzerinde tespit edilen 23 hasta dahil edildi. Yaş 1ay-18 yaş arasındaydı. Kas hastalığı bulunanlar, postoperatif hastalar ve kronik böbrek yetmezliği hastaları dahil edilmedi.
Bulgular: Hastaların yaş ortancası 71 ay (41-141 ay) idi. En sık üç neden enfeksiyon (n=11, 47%), zehirlenme (n=5, %21,7) ve metabolik hastalık (n=4, 17,3%) idi. Hastaların yatış ortalama CK değeri 53.570 ±32.371IU/L iken, pik CK değeri 88.936 IU/L (60.558-122.962) idi. On bir hastada (% 47.8) ABY gelişti. Altı hastaya (%26) sürekli renal replasman tedavisi (SRRT) uygulandı. Böbrek yetmezliği gelişenler ile gelişmeyenler arasında;(Pediatric Risk of Mortality) PRISM skorları, yatış sırasında bakılan BUN, kreatinin, ürik asit ve kalsiyum değerleri arasındaki farklılık anlamlı iken, CK değerlerindeki farklılık anlamlı değildi.. Mekanik ventilatör, inotrop, ekstrakorporeal tedavi ihtiyacı olanlar ile üç ve üzerinde organ yetmezliği gelişen hastalarda böbrek ye
Key words: Keywords: Pediatric intensive care, Rhabdomyolysis, Creatinine kinase, Acute kidney injury, Prognosis, Mortality
Anahtar kelimeler: Çocuk yoğun bakım, Rabdomiyoliz, Kreatinin kinaz, Akut böbrek yetmezliği, Prognoz, Mortalite
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