Exertional Rhabdomyolysis in Athletes: Systematic Review and Current Perspectives.


Journal

Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine
ISSN: 1536-3724
Titre abrégé: Clin J Sport Med
Pays: United States
ID NLM: 9103300

Informations de publication

Date de publication:
01 03 2023
Historique:
received: 19 11 2021
accepted: 07 09 2022
entrez: 6 3 2023
pubmed: 7 3 2023
medline: 9 3 2023
Statut: ppublish

Résumé

Exertional rhabdomyolysis results from a breakdown of skeletal muscle cells after intense exercise in otherwise healthy patients, causing increased levels of creatine kinase (CK) or myoglobin, as well as urine dipstick positive for blood, and may result in kidney insufficiency. The aim of this study was to outline the current perspectives of exertional rhabdomyolysis in athletes and subsequent treatment based on the current literature. We searched the MEDLINE/PubMed and Google databases for ([exercise] OR [exertional]) AND rhabdomyolysis following the PRISMA guidelines. All abstracts were reviewed by 2 independent examiners. Inclusion criteria consisted of original articles presenting studies on exertional rhabdomyolysis or exercise-induced rhabdomyolysis with 7 or more cases. All case reports, case series, or editorials were excluded. A total of 1541-abstracts were screened, leaving 25 studies for final inclusion and analysing 772patients. Especially, young male patients were affected at a mean age of 28.7 years (range 15.8-46.6 years). Most of the athletes performed running, including marathons in 54.3% of cases (n = 419/772), followed by weightlifting in 14.8% (n = 114/772). At the time of presentation, the mean creatine kinase was 31 481 IU/L (range 164-106,488 IU/L). Seventeen studies reported the highest level of CK, which was 38 552 IU/L (range 450-88,496 IU/L). For treatment, hydration was the most common method of choice reported by 8 studies. Exertional rhabdomyolysis seems to be underestimated, and it is essential to screen patients who present with muscle soreness/cramps and/or dark urine after heavy endurance events to avoid any further complications. II; systematic review.

Identifiants

pubmed: 36877581
doi: 10.1097/JSM.0000000000001082
pii: 00042752-202303000-00015
doi:

Substances chimiques

Creatine Kinase EC 2.7.3.2

Types de publication

Systematic Review Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

187-194

Informations de copyright

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.

Références

Tintinalli JE, Kelen GD, Stapczynski JS. Emergency Medicine: A Comprehensive Study Guide. Vol 6. New York, NY: McGraw-Hill Inc; 2004.
Backer HC, Busko M, Krause FG, et al. Exertional rhabdomyolysis and causes of elevation of creatine kinase. Phys Sportsmed. 2020; 48:179–185.
Leverenz D, Zaha O, Crofford LJ, et al. Causes of creatine kinase levels greater than 1000 IU/L in patients referred to rheumatology. Clin Rheumatol. 2016;35:1541–1547.
Scalco RS, Snoeck M, Quinlivan R, et al. Exertional rhabdomyolysis: physiological response or manifestation of an underlying myopathy? BMJ Open Sport Exerc Med. 2016;2:e000151.
Kim J, Lee J, Kim S, et al. Exercise-induced rhabdomyolysis mechanisms and prevention: a literature review. J Sport Health Sci. 2016;5:324–333.
Grunau BE, Pourvali R, Wiens MO, et al. Characteristics and thirty-day outcomes of emergency department patients with elevated creatine kinase. Acad Emerg Med. 2014;21:631–636.
Amir KA, Chen SX, Bobba RK, et al. Elevation of serum creatine phosphokinase in hospitalized patients. Am J Med Sci. 2009;338:353–356.
Rawson ES, Clarkson PM, Tarnopolsky MA. Perspectives on exertional rhabdomyolysis. Sports Med. 2017;47(suppl 1):33–49.
Line RL, Rust GS. Acute exertional rhabdomyolysis. Am Fam Physician. 1995;52:502–506.
Paul GL, DeLany JP, Snook JT, et al. Serum and urinary markers of skeletal muscle tissue damage after weight lifting exercise. Eur J Appl Physiol Occup Physiol. 1989;58:786–790.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.
Knapik JJ, O'Connor FG. Exertional rhabdomyolysis: epidemiology, diagnosis, treatment, and prevention. J Spec Oper Med Fall. 2016;16:65–71.
Mathes T, Pieper D. Clarifying the distinction between case series and cohort studies in systematic reviews of comparative studies: potential impact on body of evidence and workload. BMC Med Res Methodol. 2017;17:107.
Abu-Zidan FM, Abbas AK, Hefny AF. Clinical “case series”: a concept analysis. Afr Health Sci. 2012;12:557–562.
Hopkins BS, Li D, Svet M, et al. CrossFit and rhabdomyolysis: a case series of 11 patients presenting at a single academic institution. J Sci Med Sport. 2019;22:758–762.
Galvez R, Stacy J, Howley A. Exertional rhabdomyolysis in seven division-1 swimming athletes. Clin J Sport Med. 2008;18:366–368.
MacDonald R, Rosner Z, Venters H. Case series of exercise-induced rhabdomyolysis in the New York City jail system. Am J Emerg Med. 2014;32:466–467.
Kim D, Ko EJ, Cho H, et al. Spinning-induced rhabdomyolysis: eleven case reports and review of the literature. Electrolyte Blood Press. 2015;13:58–61.
Schiff HB, MacSearraigh ET, Kallmeyer JC. Myoglobinuria, rhabdomyolysis and marathon running. Q J Med. 1978;47:463–472.
Hou SK, Chiu YH, Tsai YF, et al. Clinical impact of speed variability to identify ultramarathon runners at risk for acute kidney injury. PLoS One. 2015; 10:e0133146.
Aalborg C, Rod-Larsen C, Leiro I, et al. An increase in the number of admitted patients with exercise-induced rhabdomyolysis. Tidsskr Nor Laegeforen. 2016;136:1532–1536.
Shumway J, Irvin A, Shia R, et al. Biomarkers, creatine kinase, and kidney function of special operation candidates during intense physiological training. Mil Med. 2020;185:e982–e987.
Arnautovic JZ, Tereziu S. Evaluation of clinical outcomes in hospitalized patients with exertional rhabdomyolysis. J Am Osteopath Assoc. 2019;119:428–434.
Luetmer MT, Boettcher BJ, Franco JM, et al. Exertional rhabdomyolysis: a retrospective population-based study. Med Sci Sports Exerc. 2020;52:608–615.
Hummel K, Gregory A, Desai N, et al. Rhabdomyolysis in adolescent athletes: review of cases. Phys Sportsmed. 2016;44:195–199.
Cutler TS, DeFilippis EM, Unterbrink ME, et al. Increasing incidence and unique clinical characteristics of spinning-induced rhabdomyolysis. Clin J Sport Med Sep. 2016;26:429–431.
Oh RC, Arter JL, Tiglao SM, et al. Exertional rhabdomyolysis: a case series of 30 hospitalized patients. Mil Med. 2015;180:201–207.
Saxena P, Dhooria S, Agarwal R, et al. Rhabdomyolysis in intensive care unit: more than One cause. Indian J Crit Care Med. 2019;23:427–429.
Cervellin G, Comelli I, Benatti M, et al. Non-traumatic rhabdomyolysis: background, laboratory features, and acute clinical management. Clin Biochem. 2017;50:656–662.
Zutt R, van der Kooi AJ, Linthorst GE, et al. Rhabdomyolysis: review of the literature. Neuromuscul Disord. 2014;24:651–659.
Fernandes PM, Davenport RJ. How to do it: investigate exertional rhabdomyolysis (or not). Pract Neurol. 2019;19:43–48.
Clarkson PM, Kearns AK, Rouzier P, et al. Serum creatine kinase levels and renal function measures in exertional muscle damage. Med Sci Sports Exerc. 2006;38:623–627.
Landau ME, Kenney K, Deuster P, et al. Exertional rhabdomyolysis: a clinical review with a focus on genetic influences. J Clin Neuromuscul Dis. 2012;13:122–136.
Update: exertional rhabdomyolysis, active component, U.S. Armed Forces 2008-2012. MSMR. 2013;20:21–24.
Update: exertional rhabdomyolysis, active component, U.S. Armed Forces, 2010-2014. MSMR. 2015;22:22–25.
Update: exertional rhabdomyolysis, active component, U.S. Armed Forces, 2015-2019. MSMR. 2020;27:10–14.
O'Connor FG, Brennan FH Jr, Campbell W, et al. Return to physical activity after exertional rhabdomyolysis. Curr Sports Med Rep. 2008;7:328–331.
Rawson ES, Gunn B, Clarkson PM. The effects of creatine supplementation on exercise-induced muscle damage. J Strength Cond Res. 2001;15:178–184.
McKinnon NB, Graham MT, Tiidus PM. Effect of creatine supplementation on muscle damage and repair following eccentrically-induced damage to the elbow flexor muscles. J Sports Sci Med. 2012;11:653–659.
Veggi KF, Machado M, Koch AJ, et al. Oral creatine supplementation augments the repeated bout effect. Int J Sport Nutr Exerc Metab. 2013;23:378–387.
Deminice R, Rosa FT, Franco GS, et al. Effects of creatine supplementation on oxidative stress and inflammatory markers after repeated-sprint exercise in humans. Nutrition. 2013;29:1127–1132.
Greenwood M, Kreider RB, Melton C, et al. Creatine supplementation during college football training does not increase the incidence of cramping or injury. Mol Cel Biochem. 2003;244:83–88.

Auteurs

Henrik C Bäcker (HC)

Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital Berlin, Berlin, Germany.
Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

John T Richards (JT)

Walter Reed National Military Medical Center, Bethesda, Maryland.

Arne Kienzle (A)

Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital Berlin, Berlin, Germany.

John Cunningham (J)

Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

Karl F Braun (KF)

Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital Berlin, Berlin, Germany.
Klinik Und Poliklinik Für Unfallchirurgie, Klinikum Rechts Der Isar der TU München, München, Germany.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH