What is the clinical evidence from this study?

Study design: Observational. Population: Rhabdomyolysis (n=343). Intervention: Age and clinical prognostic factors. Primary outcome: 30-day in-hospital mortality (p=0.003).

August 29, 2023Open Access

Rhabdomyolysis in older adults: outcomes and prognostic factors

AMAnne-Gäelle MorinEuroAcademy DSDominique SommeCentre National de la Recherche Scientifique ACAline CorvolCentre Hospitalier Universitaire de Rennes

Key Result

In adults hospitalized with rhabdomyolysis, age, Charlson comorbidity score, initial qSOFA score, peak creatinine, and disseminated intravascular coagulation were independent predictors of 30-day in-hospital mortality.

Study Design

Type

Observational (n=343)

Multicenter

Structured PICO

Population

343 adults (median age 75 years) hospitalized with rhabdomyolysis (CPK >1000 IU/L), evaluated to determine if prognostic factors for 30-day in-hospital mortality vary by age.

Outcome

30-day in-hospital mortalityhard clinical

Prognostic factors for rhabdomyolysis severity, including age, Charlson score, qSOFA, peak creatinine, and DIC, vary by age, highlighting the need for age-specific prognostic criteria in older adults.

Main Result

p-value: p=0.003

Limitations

High amount of missing data due to the retrospective design of the study.
124 patients were transferred to local hospitals, resulting in missing data for biological evolution, complications, and 30-day in-hospital mortality.
Lack of data to ensure the exhaustivity of rhabdomyolysis coding in the medico-administrative database.
The definition of acute renal failure used (30% decrease in estimated GFR) is not consensual and carries a risk of misclassification in older patients with low baseline creatinine.

Abstract

Abstract Background : Rhabdomyolysis is a common condition in older persons, often associated with falls. However, prognostic factors of rhabdomyolysis have mainly been studied in middle-aged populations. This study aims to examine whether factors related to 30-day hospital mortality vary with patients’ age. Methods: This single-center retrospective observational study included all patients admitted at the University Hospital of Rennes between 2013 and 2019 whose creatine phosphokinase (CPK) level was greater than five times the normal concentration. The primary endpoint was 30-day in-hospital mortality. Results: 343 patients were included (median age: 75 years). The mean peak CPK was 21.825 IU/L. ; acute renal failure occurred in 57.7% of cases. For patients aged 70 years and over, a long lie after a fall were the main etiology. The in-hospital mortality rate at 30 days was 10.5% (23 deaths). The Charlson score, number of medications, CPK and creatinine levels varied according to age. Age was also a factor that was not proportionally associated with 30-day hospital mortality according to a multivariate analysis. Conclusion: Factors influencing the severity of rhabdomyolysis are not evenly distributed according to age. The term rhabdomyolysis may encompass various clinical realities and be associated with different mechanisms. More research is needed to better understand physiopathological and prognostic factors of rhabdomyolysis, especially in the older population.

KI fragen

Bookmark

View Full Paper