RELATIONSHIP BETWEEN ELEVATED CREATINE-PHOSPHOKINASE AND THE CLINICAL SPECTRUM OF RHABDOMYOLYSIS

The incidence, causes and complications of severe rhabdomyolysis (creatine phosphokinase (CK) greater-than-or-equal-to 5000 U/1) were studied during a 7-year study period in a large university hospital population. This condition was present in 0.074% of all admitted patients. The mortality in the study group (n = 93) was 32% and the incidence of acute renal failure (ARF) 51%. Ischaemia was the most frequent cause, and drugs, alcohol and/or coma were the second most common cause of severe rhabdomyolysis. Patients with rhabdomyolysis due to ischaemia were older, had ARF more often, and also had the highest mortality. Hyperkalaemia (potassium greater-than-or-equal-to 5.5 mmol/1) occurred in 13% of the patients, and all of them had or developed an impaired renal function. Hypocalcaemia (calcium greater-than-or-equal-to 2.00 mmol/l) was found in 41%. The incidence of ARF and electrolyte disturbances was higher in patients with CK levels exceeding 15000 U/l. Mortality was significantly higher in patients with ARF. Plasma concentrations of potassium and calcium correlated better with the severity of renal failure than with the maximal height of plasma CK.