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.

中文翻译：

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重症监护收治的创伤患者第 30 天严重横纹肌溶解症死亡率评估：Traumabase 登记处的倾向评分分析


创伤性横纹肌溶解症 （RM） 很常见，与急性肾损伤的发展有关，并可能与其他器官功能障碍有关。因此，RM 可能会增加死亡风险。主要目的是使用因果推断方法评估严重 RM （肌酸激酶 [CK] > 5000 U/L） 对创伤患者 30 天死亡率的影响。在 2012 年 1 月 1 日至 2023 年 7 月 1 日期间在法国使用国家重大创伤登记处 （Traumabase） 进行的这项多中心队列研究中，包括所有在重症监护病房 （ICU） 住院并进行 CK 测量的参与重大创伤中心收治的患者。使用 30 天死亡率和暴露的混杂变量来确定倾向评分。具有逆处理加权的双重稳健方法能够计算对处理者的平均处理效果 （ATT）。对整个队列以及两个亚组进行了分析： 出血性休克亚组 （HS） 和创伤性脑损伤亚组 （TBI）。进行了敏感性分析。在纳入的 8592 例患者中，1544 例 （18.0%） 患有重度 RM。他们主要是男性 （78.6%），中位 [IQR] 年龄为 41 [27-58] 岁，严重受伤 （ISS 20 [13-29]），主要由钝挫伤 （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]。与整个队列一样，TBI 亚组对死亡率没有影响。重度 RM 与 ICU 住院期间更严重的创伤和更多的并发症 （无论是否与肾功能相关） 相关。多器官衰竭 （39.9% 对 12.4%） 或感染性休克 （2.6% 对 0.8%） 在重度 RM 患者中更常见。考虑到整个队列，重度 RM 与 30 天死亡率无关。然而，它与并发出血性休克患者 30 天死亡率增加 4.0% 相关。重度 RM 在 ICU 发病率中起着重要作用。