Creatine kinase as a prognostic indicator in electrical injury

• Published in: Surgery Vol. 104; no. 4; p. 741
• Main Authors: Ahrenholz, D H, Schubert, W, Solem, L D
• Format: Journal Article
• Language: English
• Published: United States 01.10.1988
• Subjects: Adolescent; Adult; Amputation; Burns, Electric - complications; Burns, Electric - enzymology; Burns, Electric - surgery; Child; Child, Preschool; Creatine Kinase - blood; Humans; Infant; Isoenzymes; Middle Aged; Myocardial Infarction - enzymology; Myocardial Infarction - etiology; Myocardium - enzymology; Prognosis; Risk Factors; Skin Transplantation
• ISSN: 0039-6060; 1532-7361

Serial serum creatine kinase (CK) and creatine kinase myocardial band isoenzyme (CK-MB) levels were obtained from 116 of 125 electrical burn patients admitted from 1976 through 1986. We divided patients into three groups (peak CK within 2 days after admission) as follows: group 1, CK less than 400 U/L; group 2, CK = 400 to 2500 U/L; group 3, CK greater than 2500 U/L. Clinical myocardial infarction (MI) was determined by ischemic ECG changes, LDH isoenzyme patterns, and clinical course. Skin grafts occurred in 2 of 24 patients from group 1, in 15 of 31 from group 2, and in 37 of 61 from group 3. Hospital stay (mean +/- SEM) was 4.6 +/- 1.3 days for group 1, 20.2 +/- 5.4 for group 2, and 37.7 +/- 3.6 for group 3. Group 1 patients required no amputations; group 2 had 1 limb and 5 digit amputations; group 3 had 22 limb and 16 digit amputations. Only three clinical MIs were found (all in group 3), although 1 of 31 patients from group 2 and 32 of 61 from group 3 had CK-MB greater than 4%. Highly elevated CK and CK-MB are associated with longer hospitalization, and a greater risk of skin grafting or amputation, than with levels less than 400 U/L. Clinical MI is rare and cannot be diagnosed by elevated CK-MB alone.