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Venous bicarbonate and creatine kinase as diagnostic and prognostic tools in the setting of acute traumatic rhabdomyolysis

J J P Buitendag, M Q Patel, S Variawa, J Fichardt, B Mostert, A Goliath, D L Clarke, G V Oosthuizen

Abstract


Background. Myorenal or crush syndrome often develops following soft-tissue traumatic injury. It is a spectrum of disease that may result in severe renal dysfunction and kidney injury requiring renal replacement therapy.

Objectives. To review a large cohort of patients with so-called myorenal or crush syndrome and assess the biochemical markers of venous bicarbonate and creatine kinase as predictors for the development of acute kidney injury (AKI).

Methods. All patients with myorenal syndrome who presented to Khayelitsha District Hospital, Cape Town, South Africa (SA), and Ngwelezana Hospital, Empangeni, KwaZulu-Natal, SA, between January and December 2017 were identified and reviewed.

Results. A total of 212 patients were included in the study. At both hospitals, 94% of the patients were male. Using the Pearson correlation coefficient, we compared creatinine kinase (CK) against serum creatinine. The mean CK level was 5 311.8 U/L and the mean creatinine level 133.457 μmol/L. The r-value was 0.2533. Although this is a technically positive correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000208. When comparing venous bicarbonate (HCO3) against creatinine, the mean HCO3 level was 22.296 mmol/L and the mean creatinine level 162.053 μmol/L. The r-value was –0.3468. Although this is a technically negative correlation, the relationship between the variables is weak. Using the Pearson R Calculator, we inserted the r-value to calculate the p-value. The p-value was 0.000013. The inverse ratio shown with HCO3 v. creatinine, although still a weak correlation, is significantly better in predicting an increase in creatinine compared with the weak positive correlation of CK v. creatinine.

Conclusions. Although both venous HCO3 and CK showed a weak correlation with creatinine, the former performed significantly better in predicting AKI. In a resource-constrained system, we recommend that HCO3 be measured to assess patients with crush injury and that CK be regarded as a complementary modality.


Authors' affiliations

J J P Buitendag, Department of Surgery, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Surgery, Khayelitsha District Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

M Q Patel, Department of Surgery, Tygerberg Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Department of Surgery, Khayelitsha District Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

S Variawa, Department of Surgery, Khayelitsha District Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

J Fichardt, Department of Surgery, Ngwelezana Hospital and Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa

B Mostert, Department of Surgery, Ngwelezana Hospital and Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa

A Goliath, Department of Surgery, Khayelitsha District Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

D L Clarke, Department of Surgery, Grey’s Hospital and Nelson R Mandela School of Medicine, College of Health Sciences,University of KwaZulu-Natal, South Africa; Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

G V Oosthuizen, Department of Surgery, Ngwelezana Hospital and Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa

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Keywords

Myorenal syndrome, Venous bicarbonate, Creatine kinase

Cite this article

South African Medical Journal 2021;111(4):333-337. DOI:10.7196/SAMJ.2021.v111i4.14915

Article History

Date submitted: 2021-03-31
Date published: 2021-03-31

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