Association of aspartate aminotransferase in statin-induced rhabdomyolysisXu Cong Ruan 1 , Lian Leng Low 2 , Yu Heng Kwan 3
1 MD Candidate; Duke-NUS Medical School, Singapore
2 Associate Consultant, Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
3 MD-PhD Candidate, Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
Correspondence to: Yu Heng Kwan, Duke-NUS Medical School, 8 College Road, 169857, Singapore. Email: email@example.com
Journal of Primary Health Care - https://doi.org/10.1071/HC17051
Published online: 12 December 2017
Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
INTRODUCTION: The risk of rhabdomyolysis in the general population is elevated by the increased prevalence of statin use. As the presentation of rhabdomyolysis is varied, there is a risk of delayed diagnosis leading to patient complications and increased healthcare costs. Creatine kinase (CK) alone is not sufficiently predictive for risk stratification. Beyond serum CK, other biomarkers such as transaminases may be used as surrogates to evaluate rhabdomyolysis severity and predict complication risks.
AIM: To assess if other biomarkers are associated with peak CK and severity of rhabdomyolysis to aid in clinical diagnosis of rhabdomyolysis.
METHODS: A retrospective study was conducted at an acute care hospital from 2008 to 2011. Inclusion criteria were: (1) patients diagnosed with statin-induced rhabdomyolysis; and (2) peak CK levels of ≥1000 IU/L. Patients with post-operational rhabdomyolysis, acute myocardial infarction and who had suffered from road traffic accidents were excluded. A total of 24,332 patients were screened, and 78 patients fulfilled our inclusion criteria.
RESULTS: Aspartate aminotransferase (AST) was found to be positively associated with peak CK levels in the multivariable linear regression model after adjusting for alanine aminotransferase (ALT) levels (P = 0.002; β = 83.18). Aspartate aminotransferase was found to be associated with severity of rhabdomyolysis in the multivariable logistics regression model after adjusting for ALT levels (P = 0.015; OR = 1.01).
DISCUSSION: Aspartate transferase is associated with raised peak CK levels and severity of rhabdomyolysis. Clinicians may consider ordering AST to aid in the clinical diagnosis of rhabdomyolysis.
KEYWORDS: Rhabdomyolysis; statins; biomarkers
References Kruger D, Han J. Assessing acquired rhabdomyolysis in adults. JAAPA 2017; 30 20–6.
| Assessing acquired rhabdomyolysis in adults.CrossRef |
 Cervellin G, Comelli I, Benatti M, et al. Non-traumatic rhabdomyolysis: background, laboratory features, and acute clinical management. Clin Biochem 2017; 50 656–62.
| Non-traumatic rhabdomyolysis: background, laboratory features, and acute clinical management.CrossRef |
 Mosshammer D, Schaeffeler E, Schwab M, Mörike K. Mechanisms and assessment of statin-related muscular adverse effects. Br J Clin Pharmacol 2014; 78 454–66.
| Mechanisms and assessment of statin-related muscular adverse effects.CrossRef | 1:CAS:528:DC%2BC2cXhsVWltbjN&md5=995aa6618aa3f185ff193fa88858d6baCAS |
 Amend KL, Landon J, Thyagarajan V, et al. Incidence of hospitalized rhabdomyolysis with statin and fibrate use in an insured US population. Ann Pharmacother 2011; 45 1230–9.
| Incidence of hospitalized rhabdomyolysis with statin and fibrate use in an insured US population.CrossRef |
 McMahon GM, Zeng X, Waikar SS, et al. A risk prediction score for kidney failure or mortality in rhabdomyolysis. JAMA Intern Med 2013; 173 1821–8.
| 1:CAS:528:DC%2BC3sXhvVCmu7fI&md5=96a8274dee45265b5e411a913d969bb4CAS |
 Bossuyt PM, Reitsma JB, Bruns DE, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ 2015; 351 h5527
 Chavez LO, Leon M, Einav S, Varon J. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Crit Care 2016; 20 135
| Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice.CrossRef |
 Banfi G, Colombini A, Lombardi G, et al. Metabolic markers in sports medicine. Adv Clin Chem 2012; 56 1–54.
| Metabolic markers in sports medicine.CrossRef | 1:CAS:528:DC%2BC38XmvVejs7o%3D&md5=25538abe9c6b8a669253b2a97aa9941bCAS |
 Raurich JM, Llompart-Pou JA, Rodriguez-Yago M, et al. Role of elevated aminotransferases in ICU patients with rhabdomyolysis. Am Surg 2015; 81 1209–15.