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J Korean Soc Emerg Med > Volume 26(5); 2015 > Article
Journal of The Korean Society of Emergency Medicine 2015;26(5): 370-378.
Early Detection and Staging of Acute Kidney Injury in Non-traumatic Rhabdomyolysis in Emergency Department
Kisoon Ryu1, Jae Yun Ahn1*, Mi Jin Lee1, Woo Young Nho2, Seong Hun Kim2
1Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
2Department of Emergency Medicine, CHA Gumi Medical Center, CHA University, Gumi, Korea
Correspondence  Jae Yun Ahn ,Tel: 053) 420-6400, Fax: 053) 428-2820, Email: portnoy8027@gmail.com,
Received: June 18, 2015; Revised: June 23, 2015   Accepted: August 14, 2015.  Published online: October 30, 2015.
Acute kidney injury (AKI) is a common, serious complication in rhabdomyolysis patients. Early recognition and adequate therapy in rhabdomyolysis-related AKI are essential to reducing mortality. However, existing biomarkers, such as plasma creatinine, have several limitations for early detection of AKI. Novel parameters have recently been studied for greater reliability in prediction and staging of AKI in critically ill patients in the emergency department. The aim of this study is to evaluate the role of certain parameters for early prediction and staging of AKI in adults with acute non-traumatic rhabdomyolysis.
Eighty eight patients with adult non-traumatic rhabdomyolysis, who were admitted to the emergency intensive care unit (ICU) from Dec 2013 to Nov 2014, were enrolled in this observational cohort study. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Diagnostic characteristics of initial laboratory parameters were analyzed using the area under the receiver operating characteristic (ROC) curve.
Of the 88 patients, 60 patients (68.2%) developed AKI during the ICU stay. The ROC curve for plasma neutrophil gelatinase-associated lipocalin (NGAL) showed the highest sensitivity (81.7%) and specificity (78.6%) among initial parameters. In pairwise comparison, the areas under the curve (AUCs) for plasma NGAL and serum creatinine were 0.868 (95% confidence interval [CI]: 0.779-0.931) and 0.765 (95% CI: 0.662-0.849), respectively. A statistically significant difference was observed in both (p=0.047). Plasma NGAL levels increased significantly as the stage of AKI progressed, using AKIN criteria (p<0.001).
Plasma NGAL can be a reliable parameter for early prediction and approximate staging of AKI in adult nontraumatic rhabdomyolysis in the emergency department.
Key words: Rhabdomyolysis, Acute kidney injury, Neutrophil gelatinase-associated lipocalin, Human, Diagnosis
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