Elevation of creatine kinase is associated with worse outcomes in 2009 pH1N1 influenza A infection

Abstract

CK is a biomarker of severity in pH1N1 infection. Elevation of CK was associated with more complications and increased ICU LOS and healthcare resources.

The hidden burden of influenza: A review of the extra‐pulmonary complications of influenza infection

“…Although elevation of creatine kinase (CK) levels was seen in all patients, a higher degree of elevation was associated with worse outcomes. Elevations of CK in influenza infection are associated with longer duration of mechanical ventilation (15 days vs 11 days, P < .001) and longer median ICU length of stay (13 days vs 8 days, P = .01) . Seven patients had muscle biopsies obtained in their evaluation—one was normal and the other six demonstrated varying degrees of necrosis, regeneration, and edema—all of which can be consistent with a diagnosis of rhabdomyolysis.…”

Severe viral pneumonia in adults: what is important for the ICU physician?

“…Unfortunately, risk factors to identify patients at high risk for ARDS development are still matter of research [14]. Sometimes, depending on the type of virus responsible for the pneumonia, viral infection can extend beyond the lung tissue; it was observed that an increase of plasmatic creatine kinase in patients with pH1N1 pneumonia is associated with higher mortality, suggesting myocarditis as potential explanation for the increase of creatine kinase [15].…”

Other Community Respiratory Viruses

“…A multicenter report of patients admitted to the intensive care units found that creatinine kinase was elevated in 24%, with greater risk of renal replacement therapy and prolonged ventilation. 10 In vitro studies suggest that muscle cells also express the a2,3 and a2,6-linked sialic acid receptors, identical to the receptors influenza use to bind respiratory epithelial cells. 11 Rhabdomyolysis, therefore, seems to likely be a manifestation of viremia.…”