Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey

Meijer, Arthur R. de; Fikkers, Bernard G.; Keijzer, M.H. de; Engelen, B.G.M. van; Drenth, J.P.H.

doi:10.1007/s00134-003-1800-5

Cited by 211 publications

(146 citation statements)

References 21 publications

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“…Serum CK levels correlated with the onset of ARF, as these patients had significantly higher admission and peak CK concentrations. The conclusion of the study was that level of CK predicted the development of ARF in patients with severe rhabdomyolysis [10]. The finding was similar to our study, which showed that the initial value of CK predicted the development of ARF in patients with rhabdomyolysis.…”

Section: Discussionsupporting

confidence: 87%

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Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Bhavsar

Rathod

et al. 2012

Indian J Surg

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Rhabdomyolysis due to trauma and burns is an important cause of acute renal failure (ARF) secondary to myoglobinuria. To prevent morbidity and mortality from ARF due to rhabdomyolysis, early detection of ARF by monitoring the biochemical parameters such as serum creatinine, serum creatine kinase (CK), and urinary myoglobin (UM) can be helpful. The aims of the study were (1) to detect ARF due to rhabdomyolysis using serum creatinine, serum CK, and UM in trauma and electrical burn patients (2) to compare utility of these parameters in early prediction of ARF in patients of rhabdomyolysis. A total of 50 patients with trauma and electrical burns were included in the study. Serum creatinine, serum CK, and UM measurements were done at the time of admission and after 48 h. Diagnosis of ARF was made in the patients by Rifle's criteria. The presence of significant elevation of creatinine, serum CK, and UM at the time of admission and after 48 h was compared in patients developing ARF by Fisher's exact test. Fifteen of the 50 patients developed ARF as per the defined criteria. Of these, 9 patients (60%) had raised level of serum creatinine above 1.4 mg% at admission and 14 patients (93.33%) had CK level >1250 U/L at admission, whereas UM was positive in 6 (40%) patients. Serum creatinine was significantly raised in all of the 15 ARF patients (100%) after 48 h of admission and serum CK was raised in 14 of the 15 ARF patients (93.33%). UM was negative in all the patients after 48 h of admission. Statistical analysis showed that rise in serum CK on admission was significantly increased in patients developing ARF as compared with serum creatinine and UM (P<0.0001). On admission, CK is a better predictor of ARF due to rhabdomyolysis than creatinine and UM. Initial creatinine is a better predictor of ARF due to rhabdomyolysis than UM. UM assay is not a good investigation for early prediction of ARF in rhabdomyolysis.

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Section: Discussionsupporting

confidence: 87%

“…In a study done by de Meijer et al [10], 26 patients with severe rhabdomyolysis were taken into the study and their clinical and laboratory data were reviewed. It was found that mean CK level was 38,351±34,354 U/L on admission and rose further in all patients (mean 59,147±67,514 U/L).…”

Section: Discussionmentioning

confidence: 99%

Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Bhavsar

Rathod

et al. 2012

Indian J Surg

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“…Other authors have reported similar findings. [7][8][9] Serum CK may be useful for the diagnosis of crush injury, rather than for risk stratification.…”

Section: Discussionmentioning

confidence: 99%

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

et al. 2017

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Background. Crush injury secondary to sjambok beatings is a well-described phenomenon in southern Africa. Owing to a number of factors, it can result in acute kidney injury (AKI). In 1992, Muckart et al. described a risk stratification system using venous bicarbonate (VB) that can be used in the management of these patients. Objective. To validate this score in the modern era of AKI risk stratification. Methods. A retrospective study was performed on a local trauma database from June 2010 to December 2012. All patients with crush injury from sjambok/blunt instrument beatings were included in the analysis. VB was compared with the Kidney Disease Improving Global Outcomes scoring system for AKI. Serum base excess (BE) and creatine kinase were also examined as biomarkers. The endpoints were the need for renal replacement therapy (RRT) and mortality. Results. Three hundred and ten patients were included. The overall mortality rate was 1.9%, 14.8% of patients had AKI, and 3.9% required RRT. Both VB and BE performed well in RRT prediction, with areas under the receiver operating characteristic curve of 0.847 (95% confidence interval (CI) 0.756 -0.938; p<0.001) and 0.871 (95% CI 0.795 -0.947; p<0.001), respectively. The sensitivity and specificity of BE were 83.3% and 80.2% at an optimal cut-point of -7.25 mmol/L, while those of VB were 83.3% and 79.5% at an optimal cut-point of 18.85 mmol/L. VB was significantly different across the AKI risk groups (p<0.001), in keeping with the original Muckart risk stratification system. Conclusion. The risk stratification score using VB is valid and should continue to be used as a tool in the management of patients with sjambok injuries. BE performs well in predicting the need for RRT, with a value of <-7.25 mmol/L indicating severe injury.

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“…Reported use of blood enzyme markers is common throughout the surgical literature [9,12,[16][17][18][20][21][22][23][24]. Rhabdomyolysis has numerous etiologies and includes local crush injury, vascular compromise, soft tissue infections, electrical injuries, excessive steroid use, seizures, surgery, and heat stroke [1,19,22].…”

Section: Discussionmentioning

confidence: 99%

“…Creatine kinase is a naturally occurring enzyme with the greatest concentrations found in skeletal muscle, cardiac muscle, and the brain [9,19]. Myoglobin also is found in cardiac and skeletal muscle and is released into the circulation when muscle is damaged through disease, exertion, or trauma and is excreted in the urine [9,16,19,20,22]. The use of serum markers, including CK, CPK, and serum myoglobin, may allow for an objective evaluation of the potential advantages among various MIS techniques.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Skeletal Muscle Serum Markers and Primary THA: A Pilot Study

Cohen

Katz

Skrepnik

2009

Clinical Orthopaedics &Amp; Related Research

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Various reports confirm elevations in serum markers associated with skeletal muscle injury after orthopaedic surgery in the absence of overt clinical manifestations of myocardial injury. We therefore measured the influence surgical approach has on these serum markers after primary THA. We nonrandomly enrolled 30 nonconsecutive patients undergoing THA in three groups of 10 based on current surgical approaches used at our facility: (1) minimally invasive (MIS) modified Watson Jones approach; (2) miniposterior transmuscular approach (MIS-I); and (3) MIS-II incision. Blood samples for hemoglobin, hematocrit, cardiac troponin I, total creatine kinase, creatine phosphokinase, and serum myoglobin were obtained the morning before surgery as a baseline, immediately postoperatively, and 72 hours thereafter. We found reproducible trends in serum enzyme levels consistent with skeletal muscle damage resulting from primary THA. Troponin I remained normal in all but one patient indicating no myocardial contribution to measured serum enzyme levels. All three procedures resulted in similar trends in serum enzyme markers relevant to primary THA. Our preliminary data suggest no surgical approach appears to affect the degree of muscle trauma more or less than another.

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Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey

Cited by 211 publications

References 21 publications

Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients

Validating the utilisation of venous bicarbonate as a predictor of acute kidney injury in crush syndrome from sjambok injuries

The Relationship Between Skeletal Muscle Serum Markers and Primary THA: A Pilot Study

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