Clinical and Hematological Characteristics of Rhabdomyolysis-Associated Kidney Injury in Military Personnel With Limb Wounds.
Military medicine · 2026-06-29 · Observational study
Abstract
INTRODUCTION: Tourniquet (TQ) use is a standard method of prehospital hemorrhage control in combat trauma. Prolonged limb ischemia with tourniquet syndrome (TS) may lead to severe skeletal muscle injury, traumatic rhabdomyolysis, and acute kidney injury (AKI). In recent armed conflicts, prolonged evacuation intervals have increased the frequency and clinical significance of these complications, while detailed clinical and laboratory descriptions remain limited. MATERIALS AND METHODS: A retrospective analysis was performed of 84 active-duty service members with combat-related extremity injuries complicated by TS and dialysis-requiring AKI, treated at a Role 4 military medical center between 2022 and 2024. Demographic, surgical, clinical, and laboratory variables were evaluated before and after renal replacement therapy (RRT). In-hospital survival was analyzed using the Kaplan-Meier method. Between-group laboratory comparisons were exploratory and descriptive. RESULTS: The mean duration of TQ application was 7.6 ± 0.5 hours. Amputation was performed in 76.2% of cases (64/84; 95% CI, 65.7%-84.8%), while the remaining patients underwent fasciotomy without amputation. All patients developed severe AKI requiring hemodialysis. At admission, laboratory findings reflected extensive muscle injury and systemic inflammation, including anemia, neutrophilic leukocytosis with lymphopenia, thrombocytopenia, and marked elevations of creatine kinase, creatinine, transaminases, ferritin, and C-reactive protein, accompanied by reduced total protein and albumin concentrations. In-hospital mortality was 14.3% (12/84; 95% CI, 7.6%-23.6%), and all deaths occurred within the first 23 days of hospitalization. CONCLUSIONS: In this retrospective Role 4 cohort, TS was associated with severe rhabdomyolysis and dialysis-requiring AKI. Coordinated surgical, critical care, and renal support were associated with short-term in-hospital stabilization in most patients, but the study design does not permit causal inference regarding treatment efficacy. Extrapolation to forward-echelon or lower-resource settings should therefore be cautious.