Admission serum myoglobin and the development of acute kidney injury after major trauma
Volume
11
Publisher
Publisher URL
DOI
10.1186/s13613-021-00924-3
Journal
ANNALS OF INTENSIVE CARE
Issue
ISSN
2110-5820
Metadata
Show full item recordAbstract
Background: Myoglobin and creatine kinase (CK) are both established markers of muscle injury but their hospital
admission values have never been compared to predict post-traumatic acute kidney injury (AKI).
Methods: An observational registry study of consecutive trauma patients admitted to a major regional trauma
centre. The primary outcome was stage 1 or more AKI in the frst 7 days after trauma. We assessed the association of
hospital admission myoglobin or CK with development of AKI both alone and when added to two existing risk prediction models for post traumatic AKI.
Results: Of the 857 trauma patients (median age 36 [25–52], 96% blunt trauma, median ISS of 20 [12–47]) included,
102 (12%) developed AKI. Admission myoglobin performed better than CK to predict AKI any stage with an AUC–ROC
of 0.74 (95% CI 0.68–0.79) and 0.63 (95% CI 0.57–0.69), respectively (p<0.001). Admission myoglobin also performed
better than CK to predict AKI stage 2 or 3 [AUC–ROC of 0.79 (95% CI 0.74–0.84) and 0.74 (95% CI 0.69–0.79), respectively (p<0.001)] with a best cutof value of 1217 µg/L (sensitivity 74%, specifcity 77%). Admission myoglobin added
predictive value to two established models of AKI prediction and showed signifcant ability to reclassify subjects
regarding AKI status, while admission CK did not. Decision curve analysis also revealed that myoglobin added net
beneft to established predictive models. Admission myoglobin was better than CK at predicting development of
signifcant rhabdomyolysis.
Conclusions: Admission myoglobin better predicts the development of AKI and severe rhabdomyolysis after major
trauma. Admission myoglobin should be added in established predictive models of post-traumatic AKI to early identify high-risk patients.