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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1999 October;40(5):637-44


lingua: Inglese

The sig­nif­i­cance of crea­tine ­kinase in car­diac ­patients ­with ­acute ­limb ischae­mia

Brow T. D., Kakk­ar V. V., Das S. K.

From the Department of Surgery The Royal Brompton Hospital, London, UK


Objective. The val­ue of creatine ­kinase (CK) and aspar­tate trans­am­i­nase (AST) has not ­been pre­vi­ous­ly eval­u­at­ed fol­low­ing car­diac sur­gery in the diag­no­sis of ­acute ­limb ischae­mia. Our objec­tive was to ­assess the val­ue of CK and AST ­with ref­er­ence to the diag­no­sis of ­limb ischae­mia, ­effect on ­renal func­tion and prog­no­sis fol­low­ing car­diac sur­gery. Design: all ­patients enter­ing ICU had dai­ly CK and AST meas­ure­ments ­over a two -year peri­od. A ret­ro­spec­tive ­study of ­patients ­with CK val­ues >5,000 U/L was per­formed. Setting: adult inten­sive ­care ­unit of a sec­on­dary and ter­tiary refer­ral cen­tre for car­di­oth­o­rac­ic sur­gery ­with on ­site facil­ities for vas­cu­lar sug­ery. Patient: twenty-sev­en ­patients had CK val­ues great­er ­than 5,000 U/L. A fur­ther ran­dom sam­ple of 35 ­patients, ­with no ­limb ischae­mia ­were ­used to ­give ­medians for CK and AST fol­low­ing car­diac sur­gery. Interventions: twelve of twen­ty-sev­en (44%) ­patients ­were not­ed to ­have acute­ly ischaem­ic ­limbs; 6 of ­these (CK>16,000 U/L) under­went sur­gi­cal inter­ven­tion. Measures: serum lev­els of CK, Peak CK, AST, Peak AST and CK/AST ­ratios. Related to pro­ce­dure and out­come in ­terms of mor­tal­i­tay and mor­bid­ity includ­ing, ­acute ­limb ischae­mia ­defined on clin­i­cal ­grounds and ­renal fail­ure ­defined as crea­ti­nine >200 µ­moles/L.
Results. The ­median val­ues for CK and AST imme­di­ate­ly fol­low­ing uncom­pli­cat­ed car­diac sur­gery ­were 135 (IQR 36-383) and 43 (IQR 26-58) respec­tive­ly. Median CK for the ­patients (CK>5,000) with­out clin­i­cal ischae­mia was 7,440 U/L com­pared to the ­group ­with ischae­mia 17,472 U/L (p<0.05). Renal fail­ure devel­oped in 48% of all ­patients. Eight of the 9 ­patients ­with CK>15,000 devel­oped ­renal fail­ure com­pared to 5 of the 13 ­with CK 5,000-15,000 U/L (p<0.01). 30% of ­patients under­went hae­mof­il­tra­tion; of ­these, 87% ­died. For ­patients ­with ischae­mia ­peak CK and crea­ti­nine cor­re­lat­ed. (r=0.83, p<0.05) Day of peak CK and ­peak AST cor­re­lat­ed (r=0.92, p<0.01). Logged val­ues of CK ­with log val­ues of AST ­showed a high­ly sig­nif­i­cant rela­tion­ship (β=1.16, p<0.001). The over­all mor­tal­ity was 33%.
Conclusions. Patients who devel­op ­limb ischae­mia fol­low­ing car­diac sur­gery ­have a ­high mor­bid­ity and mor­tal­ity. A CK of 17,000 UIL (5667-46539) is indic­a­tive of seri­ous ­limb ischae­mia. Renal fail­ure is like­ly to devel­op in ­patients ­with CK>15,000 U/L. AST may ­become a use­ful addi­tion­al mark­er of ­limb ischae­mia.

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