Development of the Mugla Score: an association-based tool for risk stratification in emergency department patients with rhabdomyolysis

Rhabdomyolysis is a potentially life-threatening syndrome characterized by skeletal muscle breakdown and systemic release of intracellular components, often resulting in acute kidney injury or death. Early risk stratification remains challenging in the emergency department (ED) setting due to heterogeneous presentations and unpredictable outcomes. To develop and internally validate the Mugla Score-a pragmatic, association-based tool for predicting adverse outcomes in ED patients with rhabdomyolysis. In this retrospective, single-center cohort study, adult ED patients with serum creatine kinase ≥ 1000 U/L between July 1, 2019, and July 1, 2024, were included. The primary outcome was a composite of renal replacement therapy or 90-day mortality. Multivariable logistic regression identified independent predictors, which were assigned weighted point values. Internal validity was assessed using five-fold cross-validation and 1,000-iteration bootstrap resampling. Among 1031 patients (mean age: 49.0 ± 21.8 years; 75.9% male), 109 (10.6%) experienced the composite outcome. Seven variables were independently associated with adverse events: age ≥ 50 years, platelet count ≤ 170 × 10³/μL, MCHC ≤ 32.8 g/dL, calcium ≤ 8.5 mg/dL, ALP ≥ 115 U/L, BEecf ≤ - 6 mmol/L, and etiological classification. The Mugla Score (range: 0-12.5) showed strong discrimination (AUC: 0.861, 95% CI: 0.824-0.898). A threshold of ≥ 4 points yielded a 97% negative predictive value. The Mugla Score provides a clinically interpretable, ED-focused tool for early risk stratification in rhabdomyolysis. While internally validated, external prospective studies are needed to assess generalizability prior to routine clinical adoption.