MedicalResearch.com Interview with:
Gearoid M. McMahon, MB, BCh
Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston,
Massachusetts Framingham Heart Study, National Heart, Lung, and Blood Institute, and Center for Population Studies, Framingham, Massachusetts
MedicalResearch.com: What are the main findings of the study?
Answer: This study examined the incidence, causes and outcomes of rhabdomyolysis in two large University Teaching hospitals. Rhabdomyolysis is a characterized by an increase in serum creatine phosphokinase (CPK) and results from muscle damage from a variety of causes. The most important complication of rhabdomyolysis is acute kidney injury which can result in a need for dialysis. Using a series of laboratory and clinical variables that are readily available on admission, we constructed a risk score that can predict with some accuracy the likelihood that a patient with rhabdomyolysis might die or need dialysis during an admission. The final variables included in the model were age, gender, the cause of rhabdomyolysis and the admission CPK, creatinine, phosphate, bicarbonate and calcium. One of the advantages of this study was, because we had access to data from two institutions, we were able to derive the risk score in one hospital and confirm its accuracy in the second institution.
MedicalResearch.com: Were any of the findings unexpected?
Answer: In the past, it has been assumed that the degree of elevation of the CPK was a marker of severity of muscle damage and was therefore the most important factor in determining prognosis. However, we found that the initial CPK level was a poor predictor of outcomes. Instead, the most important determinants of a poor outcome were advanced age, the cause of rhabdomyolysis and the admission levels of phosphate and creatinine.
MedicalResearch.com: What should clinicians and patients take away from your report?
Answer: Using the risk calculator, patients with rhabdomyolysis can be stratified on admission into higher and lower risk categories. This could allow clinicians to be less aggressive with therapy in lower risk patients and thus potentially reduce the cost of these admissions.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Answer: Although this study was conducted in two institutions, these are large, tertiary facilities and it is uncertain whether or not this risk score would definitely be applicable outside this setting. It would be important validate the score in different settings – smaller hospitals and in the community.
Gearoid M. McMahon, MB, BCh; Xiaoxi Zeng, MD; Sushrut S. Waikar, MD, MPH
JAMA Intern Med. 2013;():-. doi:10.1001/jamainternmed.2013.9774.