Top

Obesity Surgery

Published in:

01-06-2018 | Original Contributions

A Nomogram Based on Clinical Factors to Predict the Serum Myoglobin Levels Following Bariatric Surgery

Authors: Yusef Moulla, Orestis Lyros, Daniela Adolf, Thorsten Kaiser, Arne Dietrich

Published in: Obesity Surgery | Issue 6/2018

Abstract

Background

Increased serum myoglobin levels following bariatric surgery can predict rhabdomyolysis, a severe postoperative complication, which can induce acute kidney injury (AKI). The aim of this study is to evaluate clinical factors to predict increased postoperative serum myoglobin levels following bariatric surgery.

Materials and Methods

Serum myoglobin levels were studied in 281obese patients undergoing bariatric surgery in the University Hospital Leipzig, Germany between May 2012 and June 2015. A linear regression model using stepwise model selection and hence a nomogram for postoperative serum myoglobin levels after bariatric surgery with statistically significant covariates were derived and verified using bootstrap sampling.

Results

Increased serum myoglobin levels were detected firstly 4 h directly after bariatric surgery (median 124 ng/ml, range 25–22,064 ng/ml). On multivariable analysis, age, body mass index (BMI), presence of Diabetes Mellitus (DM) type II, duration of bariatric surgery, and preoperative serum myoglobin levels were significant predictors for increased serum myoglobin levels postoperatively. Furthermore, the patients were classified according to bariatric surgery duration and BMI into groups. Patients with BMI ≥ 60 kg/m² and operating time (OP-Time) ≥ 160 min demonstrated the highest postoperative serum myoglobin levels (32% with values ≥ 3000 ng/ml) and had significantly higher postoperative morbidity including rhabdomyolysis, AKI, and compartment syndrome.

Conclusion

We provide a clinical nomogram for prediction of serum myoglobin levels following bariatric surgery, which may improve clinicians’ abilities to stratify bariatric patients in risk of developing rhabdomyolysis during the postoperative course, but requires further validation.

Lagandré S, Arnalsteen L, Vallet B, et al. Predictive factors for rhabdomyolysis after bariatric surgery. Obes Surg. 2006;16(10):1365–70. https://doi.org/10.1381/096089206778663643.CrossRefPubMed

Zhang MH. Rhabdomyolysis and its pathogenesis. World J Emerg Med. 2012;3(1):11–5. https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.01.002.CrossRefPubMedPubMedCentral

Kasaoka S, Todani M, Kaneko T, et al. Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis. J Crit Care. 2010;25(4):601–4. https://doi.org/10.1016/j.jcrc.2010.04.002.CrossRefPubMed

Wu AH, Laios I, Green S, et al. Immunoassays for serum and urine myoglobin: myoglobin clearance assessed as a risk factor for acute renal failure. Clin Chem. 1994;40(5):796–802.PubMed

Ohman EM, Casey C, Bengtson JR, et al. Early detection of acute myocardial infarction: additional diagnostic information from serum concentrations of myoglobin in patients without ST elevation. Br Heart J. 1990;63(6):335–8. https://doi.org/10.1136/hrt.63.6.335.CrossRefPubMedPubMedCentral

Cervellin G, Comelli I, Lippi G. Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features. Clin Chem Lab Med. 2010;48(6):749–56. https://doi.org/10.1515/CCLM.2010.151.CrossRefPubMed

Ettinger JE, de Souza CA, Santos-Filho PV, et al. Rhabdomyolysis: diagnosis and treatment in bariatric surgery. Obes Surg. 2007;17(4):525–32. https://doi.org/10.1007/s11695-007-9091-5.CrossRefPubMed

Steyerberg EW. Clinical prediction models: a practical approach to development, validation, and updating. New York, London: Springer; 2009. https://doi.org/10.1007/978-0-387-77244-8.CrossRef

Chakravartty S, Sarma DR, Patel AG. Rhabdomyolysis in bariatric surgery: a systematic review. Obes Surg. 2013;23(8):1333–40. https://doi.org/10.1007/s11695-013-0913-3.CrossRefPubMed

10.

Stroh C, Meyer F, Lippert H, et al. Rhabdomyolysis after bariatric surgery by Roux-en-Y gastric bypass: a prospective study. Obes Surg. 2010;20(2):261–262; author reply 263. https://doi.org/10.1007/s11695-009-0029-y.CrossRefPubMed

11.

Youssef T, Abd-Elaal I, Zakaria G, et al. Bariatric surgery: rhabdomyolysis after open Roux-en-Y gastric bypass: a prospective study. Int J Surg. 2010;8(6):484–8. https://doi.org/10.1016/j.ijsu.2010.06.014.CrossRefPubMed

12.

Mognol P, Vignes S, Chosidow D, et al. Rhabdomyolysis after laparoscopic bariatric surgery. Obes Surg. 2004;14(1):91–4. https://doi.org/10.1381/096089204772787356.CrossRefPubMed

13.

Lima RS, da Silva Junior GB, Liborio AB, et al. Acute kidney injury due to rhabdomyolysis. Saudi J Kidney Dis Transpl. 2008;19(5):721–9.PubMed

14.

Mikkelsen TS, Toft P. Prognostic value, kinetics and effect of CVVHDF on serum of the myoglobin and creatine kinase in critically ill patients with rhabdomyolysis. Acta Anaesthesiol Scand. 2005;49(6):859–64. https://doi.org/10.1111/j.1399-6576.2005.00577.x.CrossRefPubMed

15.

Brancaccio P, Lippi G, Maffulli N. Biochemical markers of muscular damage. Clin Chem Lab Med. 2010;48(6):757–67. https://doi.org/10.1515/CCLM.2010.179.CrossRefPubMed

16.

Russ PD, Dillingham M. Demonstration of CT hyperdensity in patients with acute renal failure associated with rhabdomyolysis. J Comput Assist Tomogr. 1991;15(3):458–63. https://doi.org/10.1097/00004728-199105000-00021.CrossRefPubMed

17.

Lappalainen H, Tiula E, Uotila L, et al. Elimination kinetics of myoglobin and creatine kinase in rhabdomyolysis: implications for follow-up. Crit Care Med. 2002;30(10):2212–5. https://doi.org/10.1097/00003246-200210000-00006.CrossRefPubMed

18.

Rosa EC, Liberatori Filho AW, Schor N, et al. Rhabdomyolysis and acute kidney failure. Rev Assoc Med Bras. 1992;42:39–45.

19.

Tolone S, Pilone V, Musella M, et al. Rhabdomyolysis after bariatric surgery: a multicenter, prospective study on incidence, risk factors, and therapeutic strategy in a cohort from South Italy. Surg Obes Relat Dis. 2016;12(2):384–90. https://doi.org/10.1016/j.soard.2015.11.005.CrossRefPubMed

Title: A Nomogram Based on Clinical Factors to Predict the Serum Myoglobin Levels Following Bariatric Surgery
Authors: Yusef Moulla
Orestis Lyros
Daniela Adolf
Thorsten Kaiser
Arne Dietrich
Publication date: 01-06-2018
Publisher: Springer US
Published in: Obesity Surgery / Issue 6/2018
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-017-3078-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

A Nomogram Based on Clinical Factors to Predict the Serum Myoglobin Levels Following Bariatric Surgery

Abstract

Background

Materials and Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Materials and Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2018

Efficacy and Safety of Stents in the Treatment of Fistula After Bariatric Surgery: a Systematic Review and Meta-analysis

Implanted Closed-Loop Gastric Electrical Stimulation (CLGES) System with Sensor-Based Feedback Safely Limits Weight Regain at 24 Months

Emotion Self-Regulation Moderates the Association Between Symptoms of ADHD and Weight Loss After Bariatric Surgery

Implications of Celiac Disease Among Patients Undergoing Gastric Bypass

Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy on Morbidly Obese, Super-Obese, and Super-Super Obese Patients for the Treatment of Morbid Obesity

Percutaneous Needle Aspiration of a Partially Deflated Intragastric Balloon: a Forgotten Modality? Review of the Literature