From the Research
D-dimer levels can increase in rhabdomyolysis, as evidenced by a recent study published in 2021 1, which found an association between D-dimer and acute kidney injury associated with rhabdomyolysis in patients with exertional heatstroke.
Introduction to Rhabdomyolysis and D-dimer
Rhabdomyolysis is a clinical and biochemical syndrome that occurs when skeletal muscle cells disrupt and release creatine phosphokinase (CK), lactate dehydrogenase (LDH), and myoglobin into the interstitial space and plasma, as described in a study from 2008 2. This condition can trigger systemic inflammation and activation of the coagulation cascade, leading to elevated D-dimer levels, which are fibrin degradation products that indicate active blood clot formation and breakdown.
Mechanism of D-dimer Elevation in Rhabdomyolysis
The relationship between rhabdomyolysis and D-dimer elevation exists because rhabdomyolysis can cause a hypercoagulable state through multiple mechanisms, including release of tissue factor from damaged muscle, activation of thrombin, and impairment of fibrinolysis, as discussed in a study from 2015 3. However, clinicians primarily diagnose rhabdomyolysis through elevated creatine kinase (CK) levels, myoglobinuria, and clinical symptoms rather than D-dimer.
Clinical Implications of D-dimer Elevation in Rhabdomyolysis
While D-dimer elevation may occur in rhabdomyolysis, it's considered a nonspecific finding that could indicate various complications of rhabdomyolysis, such as disseminated intravascular coagulation (DIC) or venous thromboembolism, rather than the primary condition itself, as noted in a study from 2017 4. A study from 2002 5 also found that tissue injury can result in increased levels of D-dimer, which may not normalize even after 14 days.
Recent Evidence on D-dimer and Rhabdomyolysis
The most recent study from 2021 1 found that D-dimer is an independent risk factor for acute kidney injury (AKI) in patients with rhabdomyolysis following exertional heatstroke. This study suggests that D-dimer levels can be used to predict the risk of AKI in patients with rhabdomyolysis.
Key Points
- D-dimer levels can increase in rhabdomyolysis
- Rhabdomyolysis can cause a hypercoagulable state, leading to elevated D-dimer levels
- D-dimer elevation is a nonspecific finding that can indicate various complications of rhabdomyolysis
- Recent evidence suggests that D-dimer is an independent risk factor for AKI in patients with rhabdomyolysis following exertional heatstroke.