Predictive model for assessing the prognosis of rhabdomyolysis patients in the intensive care unit

Yaxin Xiong; Hongyu Shi; Jianpeng Wang; Quankuan Gu; Yu Song; Weilan Kong; Jun Lyu; Mingyan Zhao; Xianglin Meng

doi:10.3389/fmed.2024.1518129

Predictive model for assessing the prognosis of rhabdomyolysis patients in the intensive care unit

Front Med (Lausanne). 2025 Jan 10:11:1518129. doi: 10.3389/fmed.2024.1518129. eCollection 2024.

Authors

Yaxin Xiong¹, Hongyu Shi¹, Jianpeng Wang¹, Quankuan Gu¹, Yu Song¹, Weilan Kong¹, Jun Lyu², Mingyan Zhao^{1

3}, Xianglin Meng^{1

3

4}

Affiliations

¹ Department of Critical Care Medicine, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China.
² Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.
³ Heilongjiang Provincial Key Laboratory of Critical Care Medicine, Harbin, Heilongjiang, China.
⁴ Department of Nuclear Medicine, Cancer Institute, Fudan University Shanghai Cancer Center, Shanghai, China.

Abstract

Background: Rhabdomyolysis (RM) frequently gives rise to diverse complications, ultimately leading to an unfavorable prognosis for patients. Consequently, there is a pressing need for early prediction of survival rates among RM patients, yet reliable and effective predictive models are currently scarce.

Methods: All data utilized in this study were sourced from the MIMIC-IV database. A multivariable Cox regression analysis was conducted on the data, and the performance of the new model was evaluated based on the Harrell's concordance index (C-index) and the area under the receiver operating characteristic curve (AUC). Furthermore, the clinical utility of the predictive model was assessed through decision curve analysis (DCA).

Results: A total of 725 RM patients admitted to the intensive care unit (ICU) were included in the analysis, comprising 507 patients in the training cohort and 218 patients in the testing cohort. For the development of the predictive model, 37 variables were carefully selected. Multivariable Cox regression revealed that age, phosphate max, RR mean, and SOFA score were independent predictors of survival outcomes in RM patients. In the training cohort, the AUCs of the new model for predicting 28-day, 60-day, and 90-day survival rates were 0.818 (95% CI: 0.766-0.871), 0.810 (95% CI: 0.761-0.855), and 0.819 (95% CI: 0.773-0.864), respectively. In the validation cohort, the AUCs of the new model for predicting 28-day, 60-day, and 90-day survival rates were 0.840 (95% CI: 0.772-0.900), 0.842 (95% CI: 0.780-0.899), and 0.842 (95% CI: 0.779-0.897), respectively.

Conclusion: This study identified crucial demographic factors, vital signs, and laboratory parameters associated with RM patient prognosis and utilized them to develop a more accurate and convenient prognostic prediction model for assessing 28-day, 60-day, and 90-day survival rates.

Implications for clinical practice: This study specifically targets patients with RM admitted to ICU and presents a novel clinical prediction model that surpasses the conventional SOFA score. By integrating specific prognostic indicators tailored to RM, the model significantly enhances prediction accuracy, thereby enabling a more targeted and effective approach to managing RM patients.

Keywords: intensive care unit; model; nomogram; prognosis; rhabdomyolysis.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by Heilongjiang Province Key R&D Program (JD22C005 and GA21C011), and the National Natural Scientific Foundation of China (82172164).