Rhabdomyolysis in Severe COVID-19: male sex, high BMI, and prone positioning confer high risk

Mokhtari, Ava K.; Maurer, Lydia R.; Christensen, Mathias A.; Moheb, Mohamad El; Naar, Leon; Alser, Osaid; Gaitanidis, Apostolos; Langeveld, Kimberly; Kapoen, Carolijn; Breen, Kerry; Velmahos, George C.; Kaafarani, Haytham M.A.

Background: Bedside experience and studies of critically ill patients with coronavirus disease 2019 (COVID-19) indicate COVID-19 to be a devastating multisystem disease. We aim to describe the incidence, associated variables, and outcomes of rhabdomyolysis in critically ill COVID-19 patients. Materials and Methods: Data for all critically ill adult patients (≥18 years old) admitted to the ICU at a large academic medical center with confirmed COVID-19 between March 13, 2020 and April 18, 2020 were prospectively collected. Patients with serum creatine kinase (CK) concentrations greater than 1000 U/L were diagnosed with rhabdomyolysis. Patients were further stratified as having moderate (serum CK concentration 1000-4999 U/L) or severe (serum CK concentration ≥5000 U/L) rhabdomyolysis. Univariate and multivariate analyses were performed to identify outcomes and variables associated with the development of rhabdomyolysis. Results: Of 235 critically ill COVID-19 patients, 114 (48.5%) met diagnostic criteria for rhabdomyolysis. Patients with rhabdomyolysis more often required mechanical ventilation (p-value<0.001), prone positioning (p-value<0.001), pharmacological paralysis (p-value<0.001), renal replacement therapy (p-value=0.010), and extracorporeal membrane oxygenation (ECMO) (p-value=0.025). They also had longer median ICU length of stay (LOS) (p-value<0.001) and hospital LOS (p-value<0.001). No difference in mortality was observed. Male sex, patients with morbid obesity, SOFA score, and prone positioning were independently associated with rhabdomyolysis. Conclusions: Nearly half of critically ill COVID-19 patients in our cohort met diagnostic criteria for rhabdomyolysis. Male sex, morbid obesity, SOFA score, and prone position were independently associated with rhabdomyolysis. Study Type: prognostic