透析を要する横紋筋融解症のリスクスコア(McMahon score)

5点以下が入院中の死亡もしくは透析施行率が2.3％であったのに対し、11点以上では61.2％と高値
また入院時のスコアが6点以上だった場合、入院中の透析導入必要性への感度は86％と高い
 
参考文献：Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: A retrospective observational evaluation. Eur J Anaesthesiol. 2016 Dec;33(12):906-912.
出典
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1: A risk prediction score for kidney failure or mortality in rhabdomyolysis.
著者: Gearoid M McMahon, Xiaoxi Zeng, Sushrut S Waikar
雑誌名: JAMA Intern Med. 2013 Oct 28;173(19):1821-8. doi: 10.1001/jamainternmed.2013.9774.
Abstract/Text: IMPORTANCE: Rhabdomyolysis ranges in severity from asymptomatic elevations in creatine phosphokinase levels to a life-threatening disorder characterized by severe acute kidney injury requiring hemodialysis or continuous renal replacement therapy (RRT).
OBJECTIVE: To develop a risk prediction tool to identify patients at greatest risk of RRT or in-hospital mortality.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 2371 patients admitted between January 1, 2000, and March 31, 2011, to 2 large teaching hospitals in Boston, Massachusetts, with creatine phosphokinase levels in excess of 5000 U/L within 3 days of admission. The derivation cohort consisted of 1397 patients from Massachusetts General Hospital, and the validation cohort comprised 974 patients from Brigham and Women's Hospital.
MAIN OUTCOMES AND MEASURES: The composite of RRT or in-hospital mortality.
RESULTS: The causes and outcomes of rhabdomyolysis were similar between the derivation and validation cohorts. In total, the composite outcome occurred in 19.0% of patients (8.0% required RRT and 14.1% died during hospitalization). The highest rates of the composite outcome were from compartment syndrome (41.2%), sepsis (39.3%), and following cardiac arrest (58.5%). The lowest rates were from myositis (1.7%), exercise (3.2%), and seizures (6.0%). The independent predictors of the composite outcome were age, female sex, cause of rhabdomyolysis, and values of initial creatinine, creatine phosphokinase, phosphate, calcium, and bicarbonate. We developed a risk-prediction score from these variables in the derivation cohort and subsequently applied it in the validation cohort. The C statistic for the prediction model was 0.82 (95% CI, 0.80-0.85) in the derivation cohort and 0.83 (0.80-0.86) in the validation cohort. The Hosmer-Lemeshow P values were .14 and .28, respectively. In the validation cohort, among the patients with the lowest risk score (<5), 2.3% died or needed RRT. Among the patients with the highest risk score (>10), 61.2% died or needed RRT.
CONCLUSIONS AND RELEVANCE: Outcomes from rhabdomyolysis vary widely depending on the clinical context. The risk of RRT or in-hospital mortality in patients with rhabdomyolysis can be estimated using commonly available demographic, clinical, and laboratory variables on admission.
JAMA Intern Med. 2013 Oct 28;173(19):1821-8. doi: 10.1001/jamainternme...

ミオグロビン尿

尿は黒褐色に変色しており、試験紙法では潜血が陽性であるが、典型的には沈渣で赤血球は認めない。

外傷後からの時間経過と血清CK値の変化

外傷後の血清CKの上昇は受傷から遅れて上昇し24～72時間後にピークとなる。

コンパートメント症候群に対する筋膜減張切開術

外傷などにより筋区画内圧が上昇し組織還流が保たれなくなった場合は、減張切開術が必要になる場合がある。

血清カリウム値と心電図変化

血清カリウム値の上昇により心室細動などの致死的な不整脈が起こるが、その前に上昇に伴い心電図変化を起こす。T波の尖鋭化、P波の消失、QRS波の拡大、サイン波様波形の順で進行していくことが多い。

横紋筋融解症のQuick View

出典
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1: 著者提供

ピーク血清CK値における腎不全の発生率

横紋筋融解症の急性腎不全合併は血清CK値の最高値と相関している。
出典
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1: Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference?
著者: Carlos V R Brown, Peter Rhee, Linda Chan, Kelly Evans, Demetrios Demetriades, George C Velmahos
雑誌名: J Trauma. 2004 Jun;56(6):1191-6.
Abstract/Text: BACKGROUND: The combination of bicarbonate and mannitol (BIC/MAN) is commonly used to prevent renal failure (RF) in patients with rhabdomyolysis despite the absence of sufficient evidence validating its use. The purpose of this study was to determine whether BIC/ MAN is effective in preventing RF in patients with rhabdomyolysis caused by trauma.
METHODS: This study was a review of all adult trauma intensive care unit (ICU) admissions over 5 years (January 1997-September 2002). Creatine kinase (CK) levels were checked daily (abnormal,>520 U/L). RF was defined as a creatinine greater than 2.0 mg/dL. Patients received BIC/MAN on the basis of the surgeon's discretion.
RESULTS: Among 2,083 trauma ICU admissions, 85% had abnormal CK levels. Overall, RF occurred in 10% of trauma ICU patients. A CK level of 5,000 U/L was the lowest abnormal level associated with RF; 74 of 382 (19%) patients with CK greater than 5,000 U/L developed RF as compared with 143 of 1,701 (8%) patients with CK less than 5,000 U/L (p < 0.0001). Among patients with CK greater than 5,000 U/L, there was no difference in the rates of RF, dialysis, or mortality between those who received BIC/MAN and those who did not. Subanalysis of groups with various levels of CK still failed to show any benefit of BIC/MAN.
CONCLUSION: Abnormal CK levels are common among critically injured patients, and a CK level greater than 5,000 U/L is associated with RF. BIC/MAN does not prevent RF, dialysis, or mortality in patients with creatine kinase levels greater than 5,000 U/L. The standard of administering BIC/MAN to patients with post-traumatic rhabdomyolysis should be reevaluated.
J Trauma. 2004 Jun;56(6):1191-6.

透析を要する横紋筋融解症のリスクスコア(McMahon score)

5点以下が入院中の死亡もしくは透析施行率が2.3％であったのに対し、11点以上では61.2％と高値
また入院時のスコアが6点以上だった場合、入院中の透析導入必要性への感度は86％と高い
 
参考文献：Rhabdomyolysis and acute kidney injury: creatine kinase as a prognostic marker and validation of the McMahon Score in a 10-year cohort: A retrospective observational evaluation. Eur J Anaesthesiol. 2016 Dec;33(12):906-912.
出典
imgimg
1: A risk prediction score for kidney failure or mortality in rhabdomyolysis.
著者: Gearoid M McMahon, Xiaoxi Zeng, Sushrut S Waikar
雑誌名: JAMA Intern Med. 2013 Oct 28;173(19):1821-8. doi: 10.1001/jamainternmed.2013.9774.
Abstract/Text: IMPORTANCE: Rhabdomyolysis ranges in severity from asymptomatic elevations in creatine phosphokinase levels to a life-threatening disorder characterized by severe acute kidney injury requiring hemodialysis or continuous renal replacement therapy (RRT).
OBJECTIVE: To develop a risk prediction tool to identify patients at greatest risk of RRT or in-hospital mortality.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 2371 patients admitted between January 1, 2000, and March 31, 2011, to 2 large teaching hospitals in Boston, Massachusetts, with creatine phosphokinase levels in excess of 5000 U/L within 3 days of admission. The derivation cohort consisted of 1397 patients from Massachusetts General Hospital, and the validation cohort comprised 974 patients from Brigham and Women's Hospital.
MAIN OUTCOMES AND MEASURES: The composite of RRT or in-hospital mortality.
RESULTS: The causes and outcomes of rhabdomyolysis were similar between the derivation and validation cohorts. In total, the composite outcome occurred in 19.0% of patients (8.0% required RRT and 14.1% died during hospitalization). The highest rates of the composite outcome were from compartment syndrome (41.2%), sepsis (39.3%), and following cardiac arrest (58.5%). The lowest rates were from myositis (1.7%), exercise (3.2%), and seizures (6.0%). The independent predictors of the composite outcome were age, female sex, cause of rhabdomyolysis, and values of initial creatinine, creatine phosphokinase, phosphate, calcium, and bicarbonate. We developed a risk-prediction score from these variables in the derivation cohort and subsequently applied it in the validation cohort. The C statistic for the prediction model was 0.82 (95% CI, 0.80-0.85) in the derivation cohort and 0.83 (0.80-0.86) in the validation cohort. The Hosmer-Lemeshow P values were .14 and .28, respectively. In the validation cohort, among the patients with the lowest risk score (<5), 2.3% died or needed RRT. Among the patients with the highest risk score (>10), 61.2% died or needed RRT.
CONCLUSIONS AND RELEVANCE: Outcomes from rhabdomyolysis vary widely depending on the clinical context. The risk of RRT or in-hospital mortality in patients with rhabdomyolysis can be estimated using commonly available demographic, clinical, and laboratory variables on admission.
JAMA Intern Med. 2013 Oct 28;173(19):1821-8. doi: 10.1001/jamainternme...

ミオグロビン尿

尿は黒褐色に変色しており、試験紙法では潜血が陽性であるが、典型的には沈渣で赤血球は認めない。