Analysis of physiological markers and risk factors for the development of rhabdomyolysis in military personnel: a systematic review

Guilherme Henrique Mattos Dantas; Rodolfo de Alkmim Moreira Nunes; Gustavo Casimiro-Lopes; Eduardo Borba Neves; Juliana Brandão Pinto de Castro; Rodrigo Gomes de Souza Vale

doi:10.1515/reveh-2022-0038

Analysis of physiological markers and risk factors for the development of rhabdomyolysis in military personnel: a systematic review

Rev Environ Health. 2022 Jul 19;38(4):613-620. doi: 10.1515/reveh-2022-0038. Print 2023 Dec 15.

Authors

Guilherme Henrique Mattos Dantas^{1

2}, Rodolfo de Alkmim Moreira Nunes^{1

2}, Gustavo Casimiro-Lopes^{2

3}, Eduardo Borba Neves⁴, Juliana Brandão Pinto de Castro^{1

2}, Rodrigo Gomes de Souza Vale^{1

2

5}

Affiliations

¹ Laboratory of Exercise and Sport (LABEES), Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil.
² Postgraduate Program in Exercise and Sport Sciences (PPGCEE), Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
³ Laboratory of Exercise Pathophysiology (LAFE), Institute of Physical Education and Sports, Rio de Janeiro State University, Rio de Janeiro, Brazil.
⁴ Postgraduate Program on Biomedical Engineering (PPGEB), Federal Technological University of Paraná (UTFPR), Curitiba, PR, Brazil.
⁵ Laboratory of Exercise Physiology, Estácio de Sá University, Cabo Frio, RJ, Brazil.

PMID: 35852130
DOI: 10.1515/reveh-2022-0038

Abstract

Objectives: To analyze case reports with individual patient data belonging to the Armed Forces submitted to specific physical or military combat training that was affected by rhabdomyolysis and identify factors that influenced the diagnosis and clinical evolution of the syndrome.

Content: We conducted a systematic review following the PRISMA guidelines and registered on PROSPERO (CRD42021242465). We searched MedLine (via PubMed), Scopus, Cochrane, Lilacs, SciELO, CINAHL, Web of Science, SPORTDiscus, ScienceDirect, and PEDro databases for studies that reported cases of military personnel affected by rhabdomyolysis.

Summary and outlook: Thirteen studies met the inclusion criteria. Forty-nine individual cases of rhabdomyolysis were analyzed. From them, it was possible to identify several associated factors, which were responsible for developing rhabdomyolysis in military personnel. Thirty military personnel (60%) practiced physical training and 20 (40%) practiced specific military combat training. The creatine kinase (CK) peak ranged from 1,040 to 410,755 U/L, with an average of 44.991 U/L, and 14 (28%) of the cases reported alteration of renal function and four militaries (8%) evolved to death condition. Physical activities performed strenuously and without proper planning conditions such as room temperature, the period without adequate water intake, the amount of equipment used during the activity contributed to the development of rhabdomyolysis in the cases of military personnel analyzed in the present study. Therefore, it is recommended that future studies investigate the relationship between the prevalence of rhabdomyolysis cases and the severity of its consequence when associated with progressive methods of training, hydration control, acclimatization to austere environments, monitoring for the existence of hereditary diseases, and control of the use of supplementary nutritional substances.

Keywords: case report; laboratory markers; military personnel; military training; rhabdomyolysis.

Publication types

Systematic Review
Review

MeSH terms

Biomarkers
Creatine Kinase
Exercise / physiology
Humans
Military Personnel*
Rhabdomyolysis* / diagnosis
Rhabdomyolysis* / epidemiology
Rhabdomyolysis* / etiology
Risk Factors

Substances

Creatine Kinase
Biomarkers