Rhabdomyolysis In Severe Viral Pneumonias In 2019

Introduction: The one of the distinguishing features of pneumonias with viral origin is an elevated level of muscle damage markers such as creatine phosphate kinase (CK), lactate dehydrogenase (LDH) and myoglobin. It was firstly found in flu A(H1N1)pdm in 2009, and the last time in 2020 in patients with COVID-19. Aims and Objectives: The main purpose of the study was the analysis of the role of elevated muscle damage markers in patients with severe pneumonia of viral origin. Methods: 100 patients with severe pneumonias were examined in 2019. The ethiology verification was performed using polymeraze chain reaction (100% positive result - RNA virus A(H1N1)/09). The myoglobin level was assesed using flow-cytometry multiplex panel (BioLegend). Results: The average age of the patients was 53 [48; 63] years, gender proportion: 56% male, 44% - female. From the whole group ARDS was confirmed in 32% pts. Of the whole group 25 patients died, 75 survivied. CK and LDH levels were significantly higher in patients who died, than those in survivors. The level of serum myoglobin was an independent factor of mortality in such patients. Using ROC-analysis the level of serum myoglobin had a greatest area under curve (AUC) about 0.801. Conclusion: An independent unfavorable factor of lethality in severe pneumonias, associated with influenza A(H1N1)/09 was th level of serum myoglobin. Traditionally it was believed that this marker indicates radmiolysis, but its full significance is not yet clear enough.