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Rhabdomyolysis in a Tertiary PICU: A 10-Year Study

Gelbart, Ben MBBS, FRACP, FCICM1; DeMarco, Renata BBiomedSc, MBBS1; David Hussey, Alexander MBBS, MRCPCH2; Namachivayam, Siva P. MRCPCH, FCICM3; McRae, Rosemary BApp Sc1; Quinlan, Catherine MB BAO, BCh, MSc, MRCPI, MD, FRACP1,4,5; Duke, Trevor MD, FRACP, FCICM6

Pediatric Critical Care Medicine: January 2018 - Volume 19 - Issue 1 - p e51-e57
doi: 10.1097/PCC.0000000000001397
Online Clinical Investigations

Objectives: Rhabdomyolysis is a disorder of muscle breakdown. The aim of this study was to describe the epidemiology of rhabdomyolysis in children admitted to a PICU and to assess the relationship between peak creatinine kinase and mortality.

Design: Retrospective cohort study in children admitted to the PICU with rhabdomyolysis between January 1, 2005, and December 31, 2014. Demographic, clinical, and outcome data were recorded. Outcomes were analyzed by level of peak creatinine kinase value (0–10,000, 10,001–50,000, > 50,000IU/L). Long-term renal outcomes were reported for PICU survivors.

Setting: A single-centre academic tertiary PICU.

Patients: Children admitted to the PICU with serum creatinine kinase level greater than 1,000 IU/L.

Interventions: None.

Measurements and Main Results: There were 182 children with rhabdomyolysis. The median peak creatinine kinase value was 3,583 IU/L (1,554–9,608). The primary diagnostic categories included sepsis, trauma, and cardiac arrest. Mortality for peak creatinine kinase values 0–10,000, 10,001–50,000, and > 50,000 IU/L were 24/138 (17%), 6/28 (21%), and 3/16 (19%), respectively (p = 0.87). Children with a peak creatinine kinase greater than 10,000 IU/L had a longer duration of mechanical ventilation and ICU length of stay than children with peak creatinine kinase less than 10,000. Renal replacement therapy was administered in 29/182 (16%). There was longer duration of mechanical ventilation (273 [141–548] vs. 73 [17–206] hr [p < 0.001]) and ICU length of stay (334 [147–618] vs. 100 [37–232] hr (p < 0.001)] in children receiving renal replacement therapy. Continuous veno-venous hemofiltration was the most common modality 23/29 (79%). Only one child required renal replacement therapy postintensive care stay, and adverse long-term renal outcomes were uncommon.

Conclusions: In children with rhabdomyolysis requiring intensive care, peak creatinine kinase was not associated with mortality but is associated with greater use of intensive care resources. Chronic kidney disease is an uncommon sequelae of rhabdomyolysis in children requiring intensive care.

1Royal Children’s Hospital, Parkville, Victoria, Australia.

2Pediatric Intensive Care, Starship Children’s Hospital, Auckland, New Zealand.

3Murdoch Children’s Research Institute, University of Melbourne, Paediatric Royal Children’s Hospital, Parkville, Victoria, Australia.

4Murdoch Children’s Research Institute, Victoria, Australia.

5University of Melbourne, Victoria, Australia.

6General Intensive Care Unit, Royal Children’s Hospital, Centre for International Child Health, University of Melbourne and MCRI, Victoria, Australia.

Dr. Gelbart designed the study, assisted with data collection, analysis, and prepared the article. Dr. DeMarco performed data collection from the medical record. Dr. Hussey performed data collection from the renal replacement database. Dr. Namachivayam performed the data analysis and reviewed the article. Dr. Quinlan extracted the long-term renal outcomes from the medical record, analyzed these data, and reviewed the article. Dr. McRae provided data from the renal replacement database and reviewed the article. Dr. Duke assisted with study design, analysis, and reviewed the article.

Dr. Gelbart disclosed that he was awarded an early investigators research grant of $15,000 Australian dollar for a randomized controlled trial of steroids and adrenaline in children admitted to the intensive care with bronchiolitis; this study is ongoing. Dr. Duke’s institution received funding from the World Health Organization and the Bill and Melinda Gates Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2018 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies