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

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2024-11-22 DOI:10.1186/s13054-024-05158-w

Thibault Martinez, Anatole Harrois, Anaïs Codorniu, Nicolas Mongardon, Matthieu Pissot, Benjamin Popoff, Marc Leone, Nathalie Delhaye, Eric Vicaut, Quentin Mathais, Vincent Legros, Jean-Luc Hanouz, Nicolas Gatulle, Véronique Ramonda, Benjamin Cohen, Mathieu Boutonnet, Julien Pottecher, Nicolas Libert

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Abstract

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. 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. 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. 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.

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评估严重横纹肌溶解症对重症监护室收治的创伤患者第 30 天死亡率的影响：创伤数据库登记的倾向得分分析

创伤性横纹肌溶解症（RM）很常见，与急性肾损伤的发生有关，也可能与其他器官功能障碍有关。因此，横纹肌溶解症可能会增加死亡风险。该研究的主要目的是采用因果推断法评估严重横纹肌溶解症（肌酸激酶 [CK] > 5000 U/L）对创伤患者 30 天死亡率的影响。在这项多中心队列研究中，研究人员纳入了所有在参与研究的主要创伤中心住院并在重症监护室（ICU）接受肌酸激酶测定的患者，研究使用的是法国国家重大创伤登记系统（Traumabase），研究时间为2012年1月1日至2023年7月1日。使用30天死亡率和暴露的混杂变量建立倾向评分。通过反向治疗加权的双重稳健方法，计算出了治疗者的平均治疗效果（ATT）。分析对象包括整个队列以及两个亚组：失血性休克亚组（HS）和创伤性脑损伤亚组（TBI）。还进行了敏感性分析。在纳入的 8592 名患者中，有 1544 人（18.0%）患有严重的 RM。他们主要为男性（78.6%），中位数[IQR]年龄为 41 [27-58] 岁，严重受伤（ISS 20 [13 - 29]）主要来自钝器创伤（90.8%）。在整个队列中，以风险差异表示的 ATT 为 0.073 [-0.054 至 0.200]。考虑到 HS 亚组中的 1311 名患者，ATT 为 0.039 [0.014 至 0.063]。与总体队列一样，创伤性脑损伤亚组对死亡率没有影响。严重急性肾功能衰竭与创伤的严重程度和重症监护室住院期间并发症（无论是否与肾功能有关）的增加有关。多器官功能衰竭（39.9% 对 12.4%）或脓毒性休克（2.6% 对 0.8%）导致的死亡率在重度 RM 患者中更为常见。在整个队列中，重度 RM 与 30 天死亡率无关。然而，在并发失血性休克的患者中，其 30 天死亡率增加了 4.0%。严重RM在重症监护室发病率中扮演着重要角色。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.