Impact of Raising Serum Myoglobin on Resuscitation of Trauma Patients with High Injury Severity Score (ISS)

Abstract

Recent studies recommend limiting the amount of crystalloid perfused during resuscitation for trauma patients. However, severely injured patients sustain extensive muscle damage with subsequent high serum myoglobin levels precipitating acute renal injury (ARI) if not treated immediately. To timely identify patients at risk of ARI, we proposed determining the strength of the correlation between the American College of Surgeons defined injury severity score (ISS) and the serum and urine myoglobin level in the early hours of arrival to the emergency room to determine the patient at higher risk of raising serum myoglobin level and subsequent renal injury. A retrospective analysis was conducted at a 400-bed community teaching hospital with a level 2 trauma section and annual admission of 750-800 patients utilizing the data in the trauma registry(2010-2017). Patients with an ISS score of 15 or above were selected and student t-test and Pearson correlation two tailed analysis was used to identify the relationship with serum myoglobin. There were 306 patients total, with 200 males (70.3%) and 106 females (29.7%) and a mean age of60.64 (SD=23.6) (range 18-96). The mean ISS was 22.3 (SD=8.5) (range16-75). The median level of serum myoglobin in the first 24 hours of admission was 848.56 ng/mL (range 22-11,197). There was a strong and significant correlation between the two variables (r=0.397, p<0.0001). The appearance of urine myoglobin with serum level of 39 ng/mL, suggest that with higher ISS acute kidney injury is likely, and should be addressed early in the patient management. We recommend that attention should be diverted toward urine alkalinization and diuretics using crystalloid following initial resuscitation.

Keywords: serum myoglobin, injury severity score, fluid resuscitation, urine myoglobin