Sukhmani Boparai, MD
Resident Physician
LSU Health Shreveport
Shreveport
Disclosure information not submitted.
Lovekirat Dhaliwal, MD
Resident
Louisiana State University Health Sciences Center, Louisiana, United States
Disclosure information not submitted.
Cesar Davila-Chapa, MD
Resident Physician
LSU Health Shreveport
Shreveport, Louisiana
Disclosure information not submitted.
Steven Conrad, MBA, MD, PhD, MCCM
Professor of Medicine, Emergency Medicine, Pediatrics, and Anesthesiology
Louisiana State University Health Sciences, United States
Disclosure information not submitted.
Prathik Krishnan, MD
Assistant Professor of Clinical Medicine
Louisiana State University Health Sciences, United States
Disclosure information not submitted.
Title: Therapeutic Plasma Exchange in Severe Rhabdomyolysis: A Case-Control Study
Introduction: Rhabdomyolysis is a serious condition that can cause acute kidney injury (AKI), compartment syndrome, severe metabolic and electrolyte derangement leading to arrhythmias, and even death. Total plasma exchange (TPE) has been used as a treatment modality to clear myoglobin, but the evidence is limited. In this study, we aim to investigate the use of TPE in critically ill rhabdomyolysis patients.
Methods: We retrospectively chart reviewed adult patients admitted to the ICU with a diagnosis of rhabdomyolysis between 2012-2021. We dichotomized patients into two groups based on whether TPE was used or not in addition to standard care. PRISMAX machines with TPE2000 filters and either 5% albumin or fresh frozen plasma were used in the TPE group.
Results: Our cohort consisted of 73 patients who were predominantly male (63%) with a mean (SD) age of 49.37 (19.73). The common comorbidities were hypertension (17%), diabetes mellitus (8%), polysubstance abuse (17%), and chronic kidney disease (4%). Initial creatinine (Cr) ranged from 1.9 to 8mg/dl (mean 4.0), creatinine phosphokinase (CPK) from 403-93232 U/L, and myoglobin from 934 to >20,000. 19 patients received TPE, and 54 patients received standard of care treatment, per physician preference. The patients who received TPE were younger (42.47 years vs. 51.94 years, p=0.0486), had similar mean creatinine on admission (3.60 vs. 3.21, p-value 0.6125) but significantly higher SOFA score (9 vs. 6.74, p=0.0181). In the TPE group, all patients required continuous venovenous hemofiltration. The overall mortality was 42% without any statistically significant difference in both subgroups, 36 % in TPE vs. 44 % in non -TPE group (OR 0.7209, p=0.5649). However, patients receiving TPE had a shorter length of stay (3.59 vs. 6.719 days, p 0.0326) which was statistically significant. 8 patients required intermittent hemodialysis (IHD)after ICU discharge, and 1 patient in the TPE group required IHD for 3 months. However, no long-term renal dysfunction was seen in any patients.
Conclusion: Our study showed no difference in mortality or long-term need for renal replacement therapy between the two groups but showed a reduced length of stay in patients undergoing TPE. Further studies are required to elucidate its indication and effect on mortality and renal outcomes.