Prospective Study of Rhabdomyolysis and Its Correlation with Acute Kidney Injury in Acutely Poisoned Patients

Abstract Background Rhabdomyolysis often occurs in patients who have been acutely poisoned, leading to effects that can range from slight elevations in serum creatine kinase (CK) levels to significant electrolyte imbalances and acute kidney injury (AKI), potentially requiring renal replacement therapy (RRT). Predictors of rhabdomyolysis-induced AKI have been inadequately investigated in poisoned patients despite the crucial need to identify those at-risk who require appropriate hydration. Aim Study the incidence of rhabdomyolysis, assess the predictive risk factors for rhabdomyolysis-induced AKI, and evaluate the prognostic significance of CK for predicting AKI among acutely poisoned patients with rhabdomyolysis. Patients and methods A prospective observational study was conducted on 50 acutely poisoned patients with rhabdomyolysis admitted to the ICU of Poison Control Center- Ain Sham University Hospital (PCC-ASUH) with poisoning-induced rhabdomyolysis during the period from the beginning of January 2023 to the end of September 2023. Patients were classified into non- AKI complicated and AKI-complicated groups and their sociodemographic, intoxication, clinical, and laboratory data, as well as treatment and outcomes were recorded, analyzed, and compared. Results The incidence of rhabdomyolysis and rhabdomyolysis-induced AKI in acutely poisoned patients admitted to the ICU was 6.6% and 34% respectively. The most common causative substance associated with rhabdomyolysis was psychotropic drugs. Substances of abuse were predominantly found in the AKI-complicated group. There was a highly significant statistical increase in the median initial and peak CK in the AKI-complicated group. Hemodialysis was done in 41.2% of the AKI-complicated group. The case fatality rate was 6%, and all of them were in the AKI-complicated group. AKI could be predicted in patients with poison-induced rhabdomyolysis using CK 982 with an AUC of 0.712, a sensitivity of 64.7%, and a specificity of 72.7%. Conclusion CK at a cut-off point 982 could be used to predict AKI in patients with poison- induced rhabdomyolysis. Recommendations Early recognition and assessment of rhabdomyolysis could help in rapid and early management to prevent AKI and improve outcomes.