Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Association of aspartate aminotransferase in statin-induced rhabdomyolysis

Xu Cong Ruan 1 , Lian Leng Low 2 , Yu Heng Kwan 3
+ Author Affiliations
- Author Affiliations

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: yuheng@u.duke.nus.edu

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.

Abstract

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


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