McMahon et al developed a score for predicting complications in a patient with rhabdomyolysis. This can help to identify a patient who may benefit from more aggressive management. The authors are from Brigham and Women’s Hospital, West China Hospital of Sichuan University, National Heart, Lung and Blood Institute and the Center for Population Studies in Massachusetts.
Patient selection: acute rhabdomyolysis
Outcomes: acute renal failure or in-hospitalmortality
Parameters:
(1) age in years
(2) gender
(3) initial serum creatinine in mg/dL
(4) initial serum calcium in mg/dL
(5) initial serum phosphate in mg/dL
(6) initial serum bicarbonate in mEq/L
(7) initial serum CK in U/L
(8) origin of rhabdomyolysis
|
Parameter |
Finding |
Points |
|
age in years |
<= 50 years of age |
0 |
|
|
51 to 70 years of age |
1.5 |
|
|
71 to 80 years of age |
2.5 |
|
|
> 80 years of age |
3 |
|
gender |
male |
0 |
|
|
female |
1 |
|
initial serum creatinine |
< 1.4 mg/dL |
0 |
|
|
1.4 to 2.2 mg/dL |
1.5 |
|
|
> 2.2 mg/dL |
3 |
|
initial serum calcium |
>= 7.5 mg/dL |
0 |
|
|
< 7.5 mg/dL |
2 |
|
initial serum phosphate |
< 4 mg/dL |
0 |
|
|
4 to 5.4 mg/dL |
1.5 |
|
|
> 5.4 mg/dL |
3 |
|
initial serum bicarbonate |
>= 19 mEq/L |
0 |
|
|
< 19 mEw/L |
2 |
|
initial serum CK |
<= 40,000 U/L |
0 |
|
|
> 40,000 |
2 |
|
origin |
seizures, syncope, exercise, statins or myositis |
0 |
|
|
other |
3 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 19
• The higher the score the greater the risk of complications.
|
Score |
Complications |
|
0 to 2 |
0% |
|
3 |
1-2% |
|
4 |
3-4% |
|
5 |
6-9% |
|
6 or 7 |
13-18% |
|
8 |
20-24% |
|
9 |
30% |
|
10 |
31-38% |
|
11 |
48% |
|
12 |
62% |
|
13 |
60-68% |
|
14 |
40-64% |
|
15 |
78-81% |
|
16 to 19 |
50-84% |
from Figure 2, page 1826.
Performance:
• The area under the ROC curve for requiring renal replacement therapy was 0.83 and for in-hospital mortality was 0.80.
Specialty: Nephrology, Clinical Laboratory, Surgery, orthopedic
