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Multicenter Study
. 2024 Nov 22;28(1):382.
doi: 10.1186/s13054-024-05158-w.

Evaluation of severe rhabdomyolysis on day 30 mortality in trauma patients admitted to intensive care: a propensity score analysis of the Traumabase registry

Thibault Martinez  1   2 , Anatole Harrois  2   3 , Anaïs Codorniu  4 , Nicolas Mongardon  5   6   7 , Matthieu Pissot  1 , Benjamin Popoff  8 , Marc Leone  9 , Nathalie Delhaye  10 , Eric Vicaut  11   12 , Quentin Mathais  13 , Vincent Legros  14 , Jean-Luc Hanouz  15 , Nicolas Gatulle  16 , Véronique Ramonda  17 , Benjamin Cohen  18 , Mathieu Boutonnet  1 , Julien Pottecher  19   20 , Nicolas Libert  21   22 ; Traumabase Group
Collaborators, Affiliations
Multicenter Study

Evaluation of severe rhabdomyolysis on day 30 mortality in trauma patients admitted to intensive care: a propensity score analysis of the Traumabase registry

Thibault Martinez et al. Crit Care. .

Abstract

Background: Traumatic rhabdomyolysis (RM) is common and associated with the development of acute kidney injury and potentially with other organ dysfunctions. Thus, RM may increase the risk of death. The primary objective was to assess the effect of severe RM (Creatine Kinase [CK] > 5000 U/L) on 30-day mortality in trauma patients using a causal inference approach.

Methods: In this multicenter cohort study conducted in France using a national major trauma registry (Traumabase) between January 1, 2012, and July 1, 2023, all patients admitted to a participating major trauma center hospitalized in intensive care unit (ICU) and with CK measurement were included. Confounding variables for both 30-day mortality and exposure were used to establish a propensity score. A doubly robust approach with inverse treatment weighting enabled the calculation of the average treatment effect on the treated (ATT). Analyses were performed in the overall cohort as well as in two subgroups: hemorrhagic shock subgroup (HS) and traumatic brain injury subgroup (TBI). Sensitivity analyses were conducted.

Results: Among the 8592 patients included, 1544 (18.0%) had severe RM. They were predominantly males (78.6%) with median [IQR] age of 41 [27-58] years and severely injured (ISS 20 [13 - 29]) mainly from blunt trauma (90.8%). In the entire cohort, the ATT, expressed as a risk difference, was 0.073 [-0.054 to 0.200]. Considering the 1311 patients in the HS subgroup, the ATT was 0.039 [0.014 to 0.063]. As in the overall cohort, there was no effect on mortality in the TBI subgroup. Severe RM was associated with greater severity of trauma and more complications (whether related to renal function or not) during the ICU stay. Mortality due to multiorgan failure (39.9% vs 12.4%) or septic shock (2.6% vs 0.8%) was more frequent among patients with severe RM.

Conclusions: Severe RM was not associated with 30-day mortality considering the overall cohort. However, it was associated with a 4.0% increase in 30-day mortality among patients with concurrent hemorrhagic shock. Severe RM plays a significant role in ICU morbidity.

Keywords: Crush syndrome; Hemorrhage; Intensive care unit; Multiple organ failure; Rhabdomyolysis; Severe trauma; Trauma related death.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study complies with the STROBE and RECORD (Additional file 4) recommendations for the conduct of retrospective observational studies [41]. It has received the approval of the Paris Nord Research Ethics Committee (IRB number 00006477) and has been declared to the French National Commission on Computing and Liberty (Commission nationale de l’informatique et des libertés, CNIL, N° 2233446). Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Kaplan–Meier survival curve of patients with or without severe rhabdomyolysis (RM). A Unweighted Kaplan–Meier survival curves in the overall cohort. B Propensity score-weighted Kaplan–Meier survival curves in the overall cohort. C. Unweighted Kaplan–Meier survival curves in the hemorrhagic shock (HS) subgroup. D Propensity score-weighted Kaplan–Meier survival curves in the HS subgroup. E Unweighted Kaplan–Meier survival curves in the traumatic brain injury (TBI) subgroup. F Propensity score-weighted Kaplan–Meier survival curves in the TBI subgroup
Fig. 3
Fig. 3
A Distribution of the prevalence of rhabdomyolysis and severe rhabdomyolysis across different severity classes: overall cohort, ISS ≤ 14, ISS 15 to 24, ISS ≥ 25, HS subgroup, and TBI subgroup.B Mortality rates among patients with severe RM across different severity classes: overall cohort, ISS ≤ 14, ISS 15 to 24, ISS ≥ 25, HS subgroup, and TBI subgroup. RM Rhabdomyolysis; ISS injury severity score; HS Hemorrhagic shock; TBI Traumatic Brain Injury
See this image and copyright information in PMC

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