Introduction: Rhabdomyolysis is the breakdown of muscle fibers releasing myoglobin and enzymes, which can cause acute kidney injury (AKI) via tubular toxicity and obstruction. AKI affects up to 60% of polytrauma patients. Diagnosis is based on clinical signs and a creatine kinase (CK) level ≥5 times normal or ≥1,000 U/L, with serial CK measurements helping to monitor risk. Early identification using tools like the McMahon score allows timely renal-protective treatment and predicts severe AKI and mortality. Methods: This retrospective study was conducted through the analysis of medical records from patients admitted to the Intensive Care Unit of the Monte Sinaí General Hospital in Guayaquil, Ecuador, between January 1, 2024, and January 1, 2025. The study was approved by the Ethics Committee of Hospital General Monte Sinaí. Informed consent was not required due to the retrospective nature of the study. Results: Fifty percent of patients with AKI required renal replacement therapy, while none in the non-AKI group did. CK levels at 72 hours were significantly higher in the AKI group (median 42,115.5 U/L vs. 4,368 U/L; p = 0.001). AKI patients had higher median APACHE II and SOFA scores at admission and on days 2 and 3 (all p < 0.01). Vasopressor use was more frequent in the AKI group (92.9% vs. 60.3%; p = 0.030). The McMahon score was significantly elevated in AKI patients (median 6.75 vs. 5; p < 0.001) and predicted AKI with an AUC of 0.838. At a cutoff of 6.25, the score showed 79% sensitivity, 86% specificity, and 86.6% accuracy. Mortality was higher in the AKI group (50% vs. 19.5%; p = 0.036). Conclusions: The McMahon Score demonstrated strong predictive ability for identifying trauma patients with rhabdomyolysis at risk of developing acute kidney injury and requiring renal replacement therapy. Our findings also confirm that higher APACHE II scores and the presence of AKI are associated with increased mortality. Early risk stratification using these tools is essential for timely intervention and may improve outcomes in this vulnerable population.
Santos et al. (Sun,) studied this question.