J Korean Soc Emerg Med.  2015 Oct;26(5):370-378. 10.0000/jksem.2015.26.5.370.

Early Detection and Staging of Acute Kidney Injury in Non-traumatic Rhabdomyolysis in Emergency Department

• Ryu K
• Ahn JY
• Lee MJ
• Nho WY
• Kim SH

• KMID: 2191693
• DOI: http://doi.org/10.0000/jksem.2015.26.5.370

Abstract

PURPOSE
Acute kidney injury (AKI) is a common, serious complication in rhabdomyolysis patients. Early recognition and adequate therapy in rhabdomyolysis-related AKI are essential to reducing mortality. However, existing biomarkers, such as plasma creatinine, have several limitations for early detection of AKI. Novel parameters have recently been studied for greater reliability in prediction and staging of AKI in critically ill patients in the emergency department. The aim of this study is to evaluate the role of certain parameters for early prediction and staging of AKI in adults with acute non-traumatic rhabdomyolysis.
METHODS
Eighty eight patients with adult non-traumatic rhabdomyolysis, who were admitted to the emergency intensive care unit (ICU) from Dec 2013 to Nov 2014, were enrolled in this observational cohort study. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Diagnostic characteristics of initial laboratory parameters were analyzed using the area under the receiver operating characteristic (ROC) curve.
RESULTS
Of the 88 patients, 60 patients (68.2%) developed AKI during the ICU stay. The ROC curve for plasma neutrophil gelatinase-associated lipocalin (NGAL) showed the highest sensitivity (81.7%) and specificity (78.6%) among initial parameters. In pairwise comparison, the areas under the curve (AUCs) for plasma NGAL and serum creatinine were 0.868 (95% confidence interval [CI]: 0.779-0.931) and 0.765 (95% CI: 0.662-0.849), respectively. A statistically significant difference was observed in both (p=0.047). Plasma NGAL levels increased significantly as the stage of AKI progressed, using AKIN criteria (p<0.001).
CONCLUSION
Plasma NGAL can be a reliable parameter for early prediction and approximate staging of AKI in adult non-traumatic rhabdomyolysis in the emergency department.

Keyword

Rhabdomyolysis; Acute kidney injury; Neutrophil gelatinase-associated lipocalin; Human; Diagnosis

MeSH Terms

Acute Kidney Injury*
Adult
Biomarkers
Cohort Studies
Creatinine
Critical Illness
Diagnosis
Emergencies*
Emergency Service, Hospital*
Humans
Intensive Care Units
Lipocalins
Mortality
Neutrophils
Plasma
Rhabdomyolysis*
ROC Curve
Sensitivity and Specificity
Creatinine
Lipocalins