PMID- 25039546
OWN - NLM
STAT- MEDLINE
DCOM- 20141006
LR  - 20191210
IS  - 1553-2712 (Electronic)
IS  - 1069-6563 (Linking)
VI  - 21
IP  - 6
DP  - 2014 Jun
TI  - Characteristics and thirty-day outcomes of emergency department patients with 
      elevated creatine kinase.
PG  - 631-6
LID - 10.1111/acem.12385 [doi]
AB  - OBJECTIVES: Rhabdomyolysis, as defined by an elevation in creatine kinase (CK), 
      may lead to hemodialysis and death in emergency department (ED) patients, but the 
      patient characteristics, associated conditions, and 30-day outcomes of patients 
      with CK values over 1,000 U/L have not been described. METHODS: All consecutive 
      ED patients with serum CK values over 1,000 U/L between January 1, 2006, and 
      December 31, 2008, were retrospectively identified from two urban hospitals. 
      Patient characteristics, ED treatment, and ED discharge diagnoses were determined 
      by medical record review. Provincial databases were linked to identify patients 
      who died or were treated with hemodialysis within 30 days. The primary outcome 
      was the combined occurrence of death or need for hemodialysis within 30 days. 
      Secondary outcomes included the incidence of acute kidney injury (AKI) and the 
      proportion of patients with initial estimated glomerular filtration rates (eGFR) 
      > 60 mL/min/1.73 m(2) who died or required hemodialysis. RESULTS: Four-hundred 
      patients were identified, the median age was 50 years (interquartile range [IQR] 
      = 35 to 69 years), and 77% were male, with 35% of patients discharged home from 
      the ED. The most common ED discharge diagnoses were related to recreational drug 
      use, infections, and traumatic or musculoskeletal complaints. Within 30 days, 32 
      (8.0%, 95% confidence interval [CI] = 5.3% to 11%) experienced primary outcomes, 
      with 18 (4.5%, 95% CI = 2.55% to 6.5%) requiring hemodialysis and 21 deaths 
      (5.3%, 95% CI = 3.1% to 7.4%). AKI occurred in 151 patients (38%, 95% CI = 33% to 
      43%). Of the 257 patients (64%) with initial eGFRs > 60 mL/min/1.73 m(2) , none 
      required hemodialysis. CONCLUSIONS: In ED patients with initial CK > 1,000 U/L, 
      the incidence of death or hemodialysis was 8% within 30 days. Patients with 
      initial eGFRs > 60 mL/min/1.73 m(2) appear to be at a low risk of these outcomes 
      from rhabdomyolysis.
CI  - (c) 2014 by the Society for Academic Emergency Medicine.
FAU - Grunau, Brian E
AU  - Grunau BE
AD  - The Department of Emergency Medicine, University of British Columbia, Vancouver, 
      BC, Canada; St. Paul's Hospital, Vancouver, BC, Canada; The Centre of Health 
      Evaluation & Outcomes Sciences, Vancouver, BC, Canada.
FAU - Pourvali, Reza
AU  - Pourvali R
FAU - Wiens, Matthew O
AU  - Wiens MO
FAU - Levin, Adeera
AU  - Levin A
FAU - Li, Jennifer
AU  - Li J
FAU - Grafstein, Eric
AU  - Grafstein E
FAU - Joo, Dan
AU  - Joo D
FAU - Scheuermeyer, Frank Xavier
AU  - Scheuermeyer FX
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - Acad Emerg Med
JT  - Academic emergency medicine : official journal of the Society for Academic 
      Emergency Medicine
JID - 9418450
RN  - 0 (Biomarkers)
RN  - EC 2.7.3.2 (Creatine Kinase)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Biomarkers/blood
MH  - Cohort Studies
MH  - Confidence Intervals
MH  - Creatine Kinase/*blood
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Glomerular Filtration Rate
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Renal Dialysis/statistics & numerical data
MH  - Retrospective Studies
MH  - Rhabdomyolysis/blood/*diagnosis/mortality/therapy
EDAT- 2014/07/22 06:00
MHDA- 2014/10/07 06:00
CRDT- 2014/07/22 06:00
PHST- 2013/10/17 00:00 [received]
PHST- 2013/12/06 00:00 [revised]
PHST- 2013/12/24 00:00 [accepted]
PHST- 2014/07/22 06:00 [entrez]
PHST- 2014/07/22 06:00 [pubmed]
PHST- 2014/10/07 06:00 [medline]
AID - 10.1111/acem.12385 [doi]
PST - ppublish
SO  - Acad Emerg Med. 2014 Jun;21(6):631-6. doi: 10.1111/acem.12385.