Association of D-dimer and acute kidney injury associated with rhabdomyolysis in patients with exertional heatstroke: an over 10-year intensive care survey

Ren Fail. 2021 Dec;43(1):1561-1568. doi: 10.1080/0886022X.2021.2008975.

Abstract

Patients with rhabdomyolysis (RM) following exertional heatstroke (EHS) are often accompanied by dysfunction of coagulation and acute kidney injury (AKI). The purpose of this study was to investigate the relationship between D-dimer and AKI in patients with RM following EHS. A retrospective study was performed on patients with EHS admitted to the intensive care unit over 10-year. Data including baseline clinical information at admission, vital organ dysfunction, and 90-day mortality were collected. A total of 84 patients were finally included, of whom 41 (48.8%) had AKI. AKI patients had more severe organ injury and higher 90-day mortality (34.1 vs.0.0%, p < 0.001) than non-AKI patients. Multivariate logistic analysis showed that D-dimer (OR 1.3, 95% CI 1.1-1.7, p = 0.018) was an independent risk factor for AKI with RM following EHS. Curve fitting showed a curve relationship between D-dimer and AKI. Two-piecewise linear regression showed that D-dimer was associated with AKI in all populations (OR 1.3, 95% CI 1.2-1.5, p < 0.001) when D-dimer <10.0 mg/L, in RM group (OR 1.3, 95% CI 1.1-1.5, p < 0.001) when D-dimer >0.4 mg/L, in the non-RM group (OR 6.4, 95% CI 1.7-23.9, p = 0.005) when D-dimer <1.3 mg/L and D-dimer did not increase the incidence of AKI in the non-RM group when D-dimer >1.3 mg/L. AKI is a life-threatening complication of RM following EHS. D-dimer is associated with AKI in critically ill patients with EHS. The relationship between D-dimer and AKI depends on whether RM is present or not.

Keywords: D-dimer; acute kidney injury; exertional heatstroke; rhabdomyolysis.

Publication types

  • Comparative Study

MeSH terms

  • Acute Kidney Injury / blood*
  • Acute Kidney Injury / etiology*
  • Acute Kidney Injury / mortality
  • Adult
  • China
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Health Care Surveys
  • Heat Stroke / complications*
  • Humans
  • Intensive Care Units
  • Linear Models
  • Logistic Models
  • Male
  • Retrospective Studies
  • Rhabdomyolysis / complications*
  • Risk Factors
  • Time Factors
  • Young Adult

Substances

  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D

Grants and funding

This work was supported by grants from the People’s Liberation Army Logistics Research Project of China (18CXZ030 and BLJ20J006), Shenzhen Science and Technology Innovation Commission (JCYJ20190806163603504), and Shenzhen Second People’s Hospital Clinical Research Fund of Guangdong Province High-level Hospital Construction Project (20173357201815, 20193357003, and 20203357014).