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Elevation of creatine kinase is associated with worse outcomes in 2009 pH1N1 influenza A infection

Bárbara Borgatta| Marcos Pérez| Loreto Vidaur| Leonardo Lorente| Lorenzo Socías| Juan Carlos Pozo| José Garnacho-Montero| Jordi Rello
Original
Volume 38, Issue 7 / July , 2012

Pages 1152 - 1161

Abstract

Background

Current medical knowledge lacks specific information regarding creatine kinase (CK) elevation in influenza A pH1N1 (2009) infection.

Objectives

Primary endpoints were correlation between CK at intensive care unit (ICU) admission and ICU mortality. Secondary endpoints were ICU length of stay (LOS), mechanical ventilation (MV), and requirement of renal replacement techniques (RRT).

Materials and methods

A prospective multicenter register included all adults admitted for severe acute respiratory insufficiency (SARI) with confirmed pH1N1 in 148 ICUs. Clinical data including demographics, comorbidities, laboratory information, organ involvement, and prognostic data were registered. Post hoc classification of subjects was determined according to CK level. Data are expressed as median (interquartile range).

Results

Five hundred and five (505) patients were evaluable. Global ICU mortality was 17.8 % without documented differences between breakpoints. CK ≥500 UI/L was documented in 23.8 % of ICU admissions, being associated with greater renal dysfunction: acute kidney injury (AKI) was more frequent (26.1 versus 17.1 %, p < 0.05) and twofold requirement of RRT [11 versus 5.6 %, p < 0.05; odds ratio (OR) = 2.09 (95 % confidence interval [CI] 1.01–4.32)]. Increase of CK ≥1,000 UI/L was associated with two or more quadrant involvement on chest X-ray (63.2 versus 40.2 %, p < 0.01) and increased intubation risk (73.9 versus 56.7 %, p = 0.07) and duration of mechanical ventilation (median 15 days versus 11 days, p < 0.01). As a result, CK ≥1,000 UI/L was associated with 5 extra days of ICU and hospital LOS.

Conclusions

CK is a biomarker of severity in pH1N1 infection. Elevation of CK was associated with more complications and increased ICU LOS and healthcare resources.

Keywords

References

  1. Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacroix J, Stelfox T, Bagshaw S, Choong K, Lamontagne F, Turgeon AF, Lapinsky S, Ahern SP, Smith O, Siddiqui F, Jouvet P, Khwaja K, McIntyre L, Menon K, Hutchison J, Hornstein D, Joffe A, Lauzier F, Singh J, Karachi T, Wiebe K, Olafson K, Ramsey C, Sharma S, Dodek P, Meade M, Hall R, Fowler RA, Canadian critical care trials group H1N1 collaborative (2009) Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA 302:1872–1879
    • View reference on PubMed
    • View reference on publisher's website
  2. Chowell G, Bertozzi SM, Colchero MA, Lopez-Gatell H, Alpuche-Aranda C, Hernandez M, Miller MA (2009) Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med 361:674–679
    • View reference on PubMed
    • View reference on publisher's website
  3. Nguyen-Van-Tam JS, Openshaw PJ, Hashim A, Gadd EM, Lim WS, Semple MG, Read RC, Taylor BL, Brett SJ, McMenamin J, Enstone JE, Armstrong C, Nicholson KG, Influenza Clinical Information Network (FLU-CIN) (2010) Risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza: United Kingdom first wave (May–September 2009). Thorax 65:645–651
    • View reference on PubMed
    • View reference on publisher's website
  4. Lee N, Chan PK, Lui GC, Wong BC, Sin WW, Choi KW, Wong RY, Lee EL, Yeung AC, Ngai KL, Chan MC, Lai RW, Yu AW, Hui DS (2011) Complications and outcomes of pandemic 2009 Influenza A (H1N1) virus infection in hospitalized adults: how do they differ from those in seasonal influenza? J Infect Dis 203:1739–1747
    • View reference on PubMed
    • View reference on publisher's website
  5. Viasus D, Paño-Pardo JR, Pachón J, Riera M, López-Medrano F, Payeras A, Fariñas MC, Moreno A, Rodríguez-Baño J, Oteo JA, Martínez-Montauti J, Torre-Cisneros J, Segura F, Gudiol F, Carratalà J; Novel Influenza A(H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI) (2011) Pneumonia complicating pandemic (H1N1) 2009: risk factors, clinical features, and outcomes. Medicine (Baltimore) 90:328–336
  6. Viasus D, Paño-Pardo JR, Pachón J, Campins A, López-Medrano F, Villoslada A, Fariñas MC, Moreno A, Rodríguez-Baño J, Oteo JA, Martínez-Montauti J, Torre-Cisneros J, Segura F, Gudiol F, Carratalà J; Novel Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI) (2011) Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain. Clin Microbiol Infect 17:738–746
    • View reference on publisher's website
  7. Martin-Loeches I, Papiol E, Rodríguez A, Díaz E, Zaragoza R, Granada RM, Socias L, Bonastre J, Valverdú M, Pozo JC, Luque P, Juliá-Narvaéz JA, Cordero L, Albaya A, Serón D, Rello J, The H1N1 SEMICYUC Working Group (2011) Acute kidney injury in critical ill patients affected by influenza A (H1N1) virus infection. Crit Care 15:R66
    • View reference on PubMed
    • View reference on publisher's website
  8. Tanaka T, Takada T, Takagi D, Takevama N, Kitazawa Y (1989) Acute renal failure due to rhabdomyolysis associated with echovirus 9 infection: a case report and review of literature. Jpn J Med 28:237–242
    • View reference on PubMed
    • View reference on publisher's website
  9. Singh U, Scheld WM (1996) Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Infect Dis 22:642–689
    • View reference on PubMed
    • View reference on publisher's website
  10. Kumar K, Guirgis M, Zieroth S, Lo E, Menkis AH, Arora RC, Freed DH (2011) Influenza myocarditis and myositis: case presentation and review of the literature. Can J Cardiol 27:514–522
    • View reference on PubMed
    • View reference on publisher's website
  11. World Health Organization (2009) Infection prevention and control in health care for confirmed or suspected cases of pandemic (H1N1) 2009 and influenza-like illnesses. http://www.who.int/csr/resources/publications/SwineInfluenza_infectioncontrol.pdf. Accesed 29 April 2011
  12. Centers for Disease Control and Prevention (2009) Interim Recommendations for Clinical Use of Influenza Diagnostic Tests During the 2009–2010 Influenza Season. http://www.cdc.gov/h1n1flu/guidance/diagnostic_tests.htm. Accesed 30 Sept 2009
  13. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On be-half of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
  14. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J (2008) Appendix: Table 2: clinical chemistry and immunology. In: Harrison’s principles of internal medicine, 17th edn. McGraw Hill Medical, New York, pp 8.738
  15. Wallach J (2000) Introduction to normal values (reference ranges). In: Interpretation of diagnostic test, 7th edn. Lippincott Williams & Wilkins, Philadelphia, p 13
  16. Brown SM, Jones BE, Jephson AR, Dean NC, Infectious Disease Society of America/American Thoracic Society (2009) Validation of the infectious disease society of america/american thoracic society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med 37:3010–3016
    • View reference on PubMed
    • View reference on publisher's website
  17. Ronco C, Levin A, Warnock DG, Mehta R, Kellum JA, Shah S, Molitoris BA, AKIN Working Group (2007) Improving outcomes from acute kidney injury (AKI): report on an initiative. Int J Artif Organs 30:373–376
  18. Pérez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quiñones-Falconi F, Bautista E, Ramírez-Venegas A, Rojas-Serrano J, Ormsby CE, Corrales A, Mondragon E, Cordova-Villalobos JA, INER Working Group on Influenza (2009) Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 361:680–689
    • View reference on publisher's website
  19. Parikh M, Dolson G, Ramanathan V, Sangsiraprapha W (2010) Novel H1N1-associated rhabdomyolysis leading to acute renal failure. Clin Microbiol Infect 16:330–332
    • View reference on PubMed
    • View reference on publisher's website
  20. Fearnley RA, Lines SW, Lewington AJ, Bodenham AR (2011) Influenza A-induced rhabdomyolysis and acute kidney injury complicated by posterior reversible encephalopathy syndrome. Anaesthesia 66:738–742. doi:10.1111/j.1365-2044.2011.06752.x
    • View reference on PubMed
    • View reference on publisher's website
  21. Ayala E, Kagawa FT, Wehner JH, Tam J, Upadhyay D (2009) Rhabdomyolysis associated with 2009 influenza A(H1N1). JAMA 17:1863–1864
    • View reference on publisher's website
  22. Shiuan-Chih Chen SC, Liu KS, Chang HR, Lee YT, Chen CC, Lee MC (2010) Rhabdomyolysis following pandemic influenza A (H1N1) infection. Neth J Med 68:317–319
    • View reference on PubMed
  23. Slobogean BL, Reilly CW, Alvarez CM (2011) Recurrent viral-induced compartment syndrome. Pediatr Emerg Care 27:660–662
    • View reference on PubMed
    • View reference on publisher's website
  24. Tosun MS, Ertekin V, Orbak Z (2012) Rhabdomyolysis-induced acute renal failure associated with 2009 influenza A (H1N1) virus infection in a child with Crigler-Najjar syndrome. J Emerg Med 42:310–311
    • View reference on PubMed
    • View reference on publisher's website
  25. Ayala E, Kagawa F, Tam J (2009) Rhabdomyolysis associated with 2009 influenza A (H1N1). JAMA 302:1863–1864
    • View reference on PubMed
    • View reference on publisher's website
  26. D’Silva D, Hewagama S, Doherty R, Korman TM, Buttery J (2009) Melting muscles: novel H1N1 influenza A associated rhabdomyolysis. Pediatr Infect Dis J 28:1138–1139
    • View reference on PubMed
    • View reference on publisher's website
  27. Gutiérrez RL, Ellis MW, Decker CF (2010) Rhabdomyolysis and pandemic (H1N1) 2009 pneumonia in adult. Emerg Infec Dis 16:565. doi:10.3201/eid1603.091818565
    • View reference on publisher's website
  28. Lai CC, Wang CY, Lin HI (2010) Rhabdomyolysis and acute kidney injury associated with 2009 pandemic influenza A (H1N1). Am J Kidney Dis 55:615. doi:10.1053/j.ajkd.2010.01.002
    • View reference on PubMed
    • View reference on publisher's website
  29. Paredes R, Verbin S (2008) Rhabdomyolysis a review of clinical presentation, etiology, diagnosis, and management. Pediatr Emerg Care 24:262–268
    • View reference on publisher's website
  30. Cervellin G, Comelli I, Lippi G (2010) Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features. Clin Chem Lab Med 48:749–756
    • View reference on PubMed
    • View reference on publisher's website
  31. Khan FY (2009) Rhabdomyolysis: a review of the literature. Neth J Med 67:272–283
    • View reference on PubMed
  32. Miller M (2011) Clinical manifestations, diagnosis, and causes of rhabdomyolysis. UptoDate. http://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-causes-of-rhabdomyolysis. Accessed 8 May 2011
  33. Bosch X, Poch E, Grau JM (2009) Rhabdomyolysis and acute kidney injury. N Engl J Med 361:62–72
    • View reference on PubMed
    • View reference on publisher's website

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