From the Guidelines
Elevated serum myoglobin is a strong indicator of muscle damage or injury, and high levels may signify a risk of acute kidney injury, which is correlated with increased mortality. This is based on recent evidence from a 2021 study published in the journal Anaesthesia, which suggests that myoglobin measurement may be more sensitive and specific than creatine phosphokinase (CPK) levels in identifying the risk of acute kidney injury 1. Myoglobin is a protein found in muscle cells that helps transport and store oxygen, and when muscle tissue is damaged, it is released into the bloodstream.
Some common causes of elevated serum myoglobin include:
- Intense exercise or physical exertion
- Muscle trauma or crush injuries
- Heart attack (myocardial infarction)
- Rhabdomyolysis (severe muscle breakdown)
- Certain medications or drug use It is essential to investigate the underlying cause of elevated serum myoglobin, as high levels can be toxic to the kidneys and may require prompt treatment, such as intravenous fluids or discontinuation of certain medications, to prevent kidney damage 1. In severe cases, dialysis may be necessary to protect the kidneys.
The measurement of plasma myoglobin can be usefully complemented by plasma potassium tests for hyperkalaemia and measurements of kidney function by means of plasma creatinine tests, as suggested by the 2021 study 1. This comprehensive approach can help identify patients at risk of acute kidney injury and guide appropriate treatment to reduce morbidity and mortality.
From the Research
Elevated Serum Myoglobin Indications
Elevated serum myoglobin levels can indicate various conditions, including:
- Muscular damage or disorders, such as muscular dystrophy 2, 3
- Renal failure, as myoglobin is usually excreted into the urine and its levels can rise in patients with impaired renal function 4
- Myocardial infarction, as myoglobin is an early marker of cardiac muscle damage 5
- Skeletal muscle damage or disorders, such as primary and secondary skeletal muscle disorders 3
- Peripheral arterial disease (PAD), as elevated myoglobin levels can be a biomarker for symptomatic PAD 6
Conditions that can Cause Elevated Serum Myoglobin
Several conditions can cause elevated serum myoglobin levels, including:
- Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) 2
- Facioscapulohumeral dystrophy and limb-girdle dystrophy 2
- Renal failure 4
- Myocardial infarction 5
- Skeletal muscle damage or disorders 3
- Peripheral arterial disease (PAD) 6
- Strenuous exercise, intramuscular injection, and certain toxins or drugs 5
Diagnostic Implications
Elevated serum myoglobin levels can have diagnostic implications, such as:
- Estimating the stage and degree of muscular damage in patients with renal failure 4
- Diagnosing myocardial infarction, particularly when combined with other markers such as troponin I 5
- Assessing muscle damage in patients with primary and secondary skeletal muscle disorders 3
- Identifying patients with symptomatic PAD and predicting patient mortality 6