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Nashwan AJ, Alassaf A, Abujaber AA, Al Wraidat M, Ananthegowda DC, Al-Kaabi SK, Othman M, Ahmad MK, Al Maslamani M, Khatib M. Rhabdomyolysis in Critically Ill Patients With COVID-19: A Retrospective Study. Cureus 2023; 15:e37333. [PMID: 37181981 PMCID: PMC10168594 DOI: 10.7759/cureus.37333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION The total number of ICU admissions for COVID-19 patients has increased steadily. Based on the research team's clinical observations, many patients developed rhabdomyolysis, but few cases were reported in the literature. This study explores the incidence of rhabdomyolysis and its outcomes, like mortality, the need for intubation, acute kidney injury, and the need for renal replacement therapy (RRT). METHODS We retrospectively reviewed the characteristics and outcomes of patients admitted to the ICU at a COVID-19-designated hospital in Qatar between March and July 2020. Logistic regression analysis was used to determine factors associated with mortality. RESULTS 1079 patients with COVID-19 were admitted to the ICU, and 146 developed rhabdomyolysis. Overall, 30.1% died (n = 44), and 40.4% developed Acute Kidney Injury (AKI) (n = 59), with only 19 cases (13%) recovering from the AKI. AKI was significantly associated with increased mortality rates among rhabdomyolysis patients. Moreover, significant differences were found between groups regarding the subject's age, calcium level, phosphorus level, and urine output. However, the AKI was the best predictor of mortality for those who got the COVID-19 infection and rhabdomyolysis. CONCLUSION Rhabdomyolysis increases the risk of death in COVID-19 patients admitted to the ICU. The strongest predictor of a fatal outcome was acute kidney injury. The findings of this study emphasize the importance of early identification and prompt treatment of rhabdomyolysis in patients with severe COVID-19.
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Affiliation(s)
| | - Anood Alassaf
- Pediatrics Department, Hamad Medical Corporation, Doha, QAT
| | | | | | | | | | | | | | | | - Mohamad Khatib
- Critical Care Medicine, Hamad Medical Corporation, Doha, QAT
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Akkanti BH, Hussain R, Patel MK, Patel JA, Dinh K, Zhao B, Elzamly S, Pelicon K, Petek K, Salas de Armas IA, Akay M, Kar B, Gregoric ID, Buja LM. Deadly combination of Vaping-lnduced lung injury and Influenza: case report. Diagn Pathol 2020; 15:83. [PMID: 32646452 PMCID: PMC7346855 DOI: 10.1186/s13000-020-00998-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND E-cigarette and vaping use-associated acute lung injury (EVALI) has been recently recognized as a complication in individuals who use vaping devices. Another consideration is that EVALI may have an adverse influence on the outcome of intercurrent respiratory infections. We document this deadly combination in the case of a young man who had EVALI and simultaneous 41 Influenza-A infection leading to severe Acute Respiratory Distress Syndrome (ARDS). CASE PRESENTATION A 27-year-old male with a history of tobacco and vaping use was admitted to hospital after two weeks of flu-like symptoms, diarrhea and vomiting. A chest x-ray was consistent with multifocal pneumonia, and microbiological tests were positive for Influenza-A and methicillin-sensitive Staphalacoccus aureus (MSSA). Bronchoscopy provided evidence of acute inhalational injury. After admission, he acutely decompensated with severe hypoxia and hypotension; he required intubation, sedation and vasopressors. He developed sepsis with acute kidney failure, liver failure, biventricular systolic dysfunction and severe rhabdomyolysis. He was placed on veno-venous (VV) extracorporeal membrane oxygenation (ECMO) initially and later changed to Veno-Arterial (VA) ECMO. Nevertheless, the patient continued to deteriorate, and he expired two weeks after admission. CONCLUSION This case documents that EVALI can act as a major factor leading a respiratory infection to progress into severe ARDS with a fatal outcome.
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Affiliation(s)
- Bindu H Akkanti
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Rahat Hussain
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Manish K Patel
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Jayeshkumar A Patel
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Kha Dinh
- Divisions of Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St. MSB 2.276, Houston, TX, 77030, USA
| | - Shaimaa Elzamly
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St. MSB 2.276, Houston, TX, 77030, USA
| | - Kevin Pelicon
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Klemen Petek
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Ismael A Salas de Armas
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Mehmet Akay
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Biswajit Kar
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Igor D Gregoric
- Advanced Cardio-Pulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), 6431 Fannin St. MSB 2.276, Houston, TX, 77030, USA.
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