Aspartate Aminotransferase and Lactate Dehydrogenase in Evaluating the Risk of Rhabdomyolysis-Induced Acute Kidney Injury: A Systematic Review and Meta-analysis

Safari, Saeed; Najafi, Iraj; Yousefifard, Mahmoud; Forouzanfar, Mohammad Mehdi; Mazloom, Hamid; Sharifi, Ali

doi:Doi:10.34172/jept.2025.15

Aspartate Aminotransferase and Lactate Dehydrogenase in Evaluating the Risk of Rhabdomyolysis-Induced Acute Kidney Injury: A Systematic Review and Meta-analysis

Document Type : Review Article

Authors

Saeed Safari ¹^{, 2}^{, 3}

Iraj Najafi ⁴

Mahmoud Yousefifard ⁵^{, 6}

Mohammad Mehdi Forouzanfar ⁷

Hamid Mazloom ⁷

Ali Sharifi ⁸

¹ Research Center for Trauma in Police Operations, Directorate of Health, Rescue and Treatment, Police Headquarters, Tehran, Iran

² Emergency Care Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

³ Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

⁴ Nephrology Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

⁵ Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran

⁶ Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran

⁷ Emergency Care Promotion Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

⁸ Hepato-Pancreatico-Biliary & Organ Transplantation Surgery Department, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.

https://doi.org/Doi:10.34172/jept.2025.15

Abstract

Introduction: This study aimed to investigate the diagnostic accuracy of serum levels of lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) in evaluating the risk of Acute Kidney Injury (AKI) following traumatic rhabdomyolysis.
Methods: A systematic review and meta-analysis were conducted by searching Medline, Embase, Scopus, and Web of Science for relevant studies up to June 2025, considering terms such as ‘‘Crush Syndrome,’’ ‘‘Crush Injury,’’ ‘‘Rhabdomyolysis,’’ AND ‘‘Serum Glutamic Oxaloacetic Transaminase,’’ ‘‘SGOT,’’ or ‘‘Aspartate Transaminase.’’ Studies that compared LDH or AST levels in traumatic rhabdomyolysis patients with and without AKI were included. The pooled effect size was evaluated using the standardized mean difference (SMD), and a 95% confidence interval (CI) was calculated. A random-effects model was employed to handle the heterogeneity. Subgroup analyses were conducted based on age group (adults and pediatrics). All analyses were performed using the statistical program STATA 17.0.
Results: For AST, the initial database search identified a total of 5,120 articles (2362 duplicates). Initially, 2,758 studies were screened by title and abstract, 52 articles were selected for full-text assessment, and finally, six articles were included in the quantitative analysis. In the case of LDH, the initial database search identified 4,044 articles (1471 duplicates). The initial 2,573 articles were screened by title and abstract, 49 articles were selected for full-text review, and finally, five studies were included in the quantitative analysis.
A total of seven studies involving 277 AKI and 2592 non-AKI patients were included in the meta-analysis. The pooled SMD for AST was 1.46 (95% CI: 0.79–2.13, I² = 88.02%) in adults and 0.80 (95% CI: 0.23–1.37, I²= 65.49%) in children. Similarly, the SMD for LDH was 2.16 (95% CI: 0.20–4.11, I² = 97.37%) in adults and 1.18 (95% CI: 0.70–1.67, I² = 32.94%) in children.
Conclusion: Current evidence suggests a significant association between elevated levels of AST and LDH and the incidence of AKI following traumatic rhabdomyolysis, with moderate and low levels of evidence, respectively. However, due to the limited number of studies, it was not possible to assess their effectiveness as a screening test.

Keywords

Meta-analysis

Aspartate aminotransferase

Lactate dehydrogenase

Rhabdomyolysis

Acute kidney injury

Subjects

Disaster

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