Peak creatinine kinase level is a key adjunct in the evaluation of critically ill trauma patients

Saskya Byerly; Elizabeth Benjamin; Subarna Biswas; Jayun Cho; Eugene Wang; Monica D Wong; Kenji Inaba; Demetrios Demetriades

doi:10.1016/j.amjsurg.2016.11.034

Peak creatinine kinase level is a key adjunct in the evaluation of critically ill trauma patients

Am J Surg. 2017 Aug;214(2):201-206. doi: 10.1016/j.amjsurg.2016.11.034. Epub 2016 Nov 24.

Authors

Saskya Byerly¹, Elizabeth Benjamin², Subarna Biswas³, Jayun Cho⁴, Eugene Wang⁵, Monica D Wong⁶, Kenji Inaba⁷, Demetrios Demetriades⁸

Affiliations

¹ Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: saskya.byerly@med.usc.edu.
² Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: elizabeth.benjamin@med.usc.edu.
³ Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: subarna.biswas@med.usc.edu.
⁴ Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: jayuncho11@gmail.com.
⁵ Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: ewangwhc@gmail.com.
⁶ Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: monica.wong@med.usc.edu.
⁷ Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: kenji.inaba@med.usc.edu.
⁸ Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: demetrios.demetriades@med.usc.edu.

PMID: 27916197
DOI: 10.1016/j.amjsurg.2016.11.034

Abstract

Background: Elevated creatinine kinase (CK) can indicate rhabdomyolysis, a risk factor for acute kidney injury (AKI). We investigated risk factors and clinical significance of peak CK levels.

Methods: Retrospective analysis, adult trauma patients. Logistic regression was used to identify risk factors for elevated CK and AKI.

Results: 3240 trauma patients were analyzed; median time to peak CK was 17 h and 347 patients had peak CK > 5000. On multivariable analysis, younger males with severe injury were more likely to have peak CK > 5000 and peak CK > 5000 was an independent risk factor for AKI (AOR 3.79). Although peak CK levels were significantly lower in older patients (1,637U/L vs 2,604U/L), older patients were more likely to develop AKI at lower CK levels.

Conclusions: CK levels commonly peak within 1-2 days after admission. Despite lower peak CK levels, older patients are more likely to develop AKI. These data may support more rigorous CK monitoring and lower intervention threshold in older patients.

Keywords: Acute kidney injury; Creatinine; Creatinine kinase; Rhabdomyolysis; Trauma.

MeSH terms

Acute Kidney Injury / blood*
Acute Kidney Injury / epidemiology*
Acute Kidney Injury / etiology
Adult
Creatine Kinase / blood*
Critical Illness
Female
Humans
Male
Middle Aged
Retrospective Studies
Risk Factors
Wounds, Nonpenetrating / blood*
Wounds, Nonpenetrating / complications
Wounds, Penetrating / blood*
Wounds, Penetrating / complications
Young Adult

Substances

Creatine Kinase