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Rhabdomyolysis in COVID-19 Patients: A Retrospective Observational Study
Magued W Haroun1, Vladyslav Dieiev1, John Kang1
1Internal Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, USA.
Insights
Rhabdomyolysis was common in hospitalized COVID-19 patients, increasing the risk of kidney replacement therapy and death. The McMahon score predicts new-onset renal replacement therapy better than creatine kinase alone.
Area of Science:
- Nephrology
- Infectious Diseases
- Critical Care Medicine
Background:
- The COVID-19 pandemic has led to significant global morbidity and mortality.
- Kidney injury is a recognized complication of COVID-19, with rhabdomyolysis suspected as a contributing factor.
- Limited data exists on the incidence and outcomes of rhabdomyolysis in COVID-19 patients.
Purpose of the Study:
- To determine the incidence of rhabdomyolysis in hospitalized COVID-19 patients.
- To describe the clinical characteristics and outcomes of these patients.
- To identify predictors of adverse outcomes, including new-onset renal replacement therapy and in-hospital mortality.
Main Methods:
- A retrospective observational cohort study of 140 hospitalized COVID-19 patients with peak total creatine kinase (CK) > 1,000 U/L.
- Data collected from March 16 to May 27, 2020, at a single center in the Bronx, New York City.
- Primary outcomes assessed were new-onset renal replacement therapy (RRT) and in-hospital mortality.
Main Results:
- The median age of patients was 68 years, with 64% males; common comorbidities included hypertension (73%) and diabetes (47%).
- Median CK on admission was 1,323 U/L; 35% received mechanical ventilation, 17.1% required RRT, and 47.1% died.
- The McMahon score was a significant predictor of new-onset RRT, outperforming isolated CK levels.
Conclusions:
- Rhabdomyolysis is a frequent finding in hospitalized COVID-19 patients.
- Patients with COVID-19 and rhabdomyolysis face higher rates of RRT and in-hospital mortality.
- Clinicians should suspect rhabdomyolysis in COVID-19 patients and utilize validated scores like the McMahon score for treatment planning.
Abstract:
Background The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide. Knowledge about the pathophysiology of the disease and its effect on multiple systems is growing. Kidney injury has been a topic of focus, and rhabdomyolysis is suspected to be one of the contributing mechanisms. However, information on rhabdomyolysis in patients affected by COVID-19 is limited. We aim to describe the incidence, clinical characteristics, and outcomes of patients hospitalized with COVID-19 who developed rhabdomyolysis. Materials and methods A retrospective observational cohort consisted of patients who were admitted and had an outcome between March 16 to May 27, 2020, inclusive of those dates at a single center in the Bronx, New York City. All consecutive inpatients with lab-confirmed COVID-19 were identified. Patients with peak total creatine kinase (CK) over 1,000 U/L were reviewed; 140 patients were included in the study. The main outcomes during hospitalization were new-onset renal replacement therapy and in-hospital mortality. Results The median age was 68 years (range: 21-93); 64% were males. The most common comorbidities were hypertension (73%), diabetes mellitus (47%), and chronic kidney disease (24%). Median CK on admission was 1,323 U/L (interquartile range [IQR]: 775 - 2,848). Median CK on discharge among survivors was 852 (IQR: 170 - 1,788). Median creatinine on admission was 1.78 mg/dL (IQR: 1.23 - 3.06). During hospitalization, 49 patients (35%) received invasive mechanical ventilation, 24 patients (17.1%) were treated with renal replacement therapy (RRT), and 66 (47.1%) died. Conclusions Rhabdomyolysis was a common finding among hospitalized patients with COVID-19 in our hospital in the Bronx. The incidence of new-onset renal replacement therapy and in-hospital mortality is higher in patients who develop rhabdomyolysis. McMahon score, rather than isolated creatine kinase levels, was a statistically significant predictor of new-onset RRT. Clinicians should maintain a high level of suspicion for rhabdomyolysis in COVID-19 patients throughout their admission and use validated scores like McMahon score to devise their treatment plan accordingly.
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