Elevated serum creatine phosphokinase is associated with mortality and inotropic requirement in critically injured adults

The association between serum uric acid and creatine phosphokinase in the general population: NHANES 2015-2018

BACKGROUND

The association between serum creatine phosphokinase (CPK), a standard biochemical measure of acute myocardial infarction, and serum uric acid (sUA) has not been studied. This study aimed to determine the association between sUA and CPK in the general population of the US.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) 2015-2018 were used, including a total of 8,431 subjects aged ≥ 30 years. Weighted multiple regression analysis was used to estimate the independent relationship between sUA and CPK. Fitted smoothing curves and weighted generalized additive models were also performed.

RESULTS

We found a positive relationship between sUA and CPK after adjusting for potential confounders. In subgroup analyses stratified by sex and race/ethnicity, sUA was positively correlated with CPK in each subgroup. The association between sUA and CPK followed an inverted U-shaped curve in females (turning point: sUA = 428.3 μmol/L).

CONCLUSIONS

Our study suggested that sUA level was positively correlated with CPK in the general population of the US. However, CPK increased with sUA until the turning point (sUA = 428.3 μmol/L) in females. Fundamental research and large sample prospective studies are needed to determine the exact mechanism of the association between sUA and CPK.

Creatine Kinase and Mortality in Peritoneal Dialysis

Background

The association between serum creatine kinase and mortality in patients with peritoneal dialysis (PD) remained unknown.

Methods

We retrospectively collected data on 3,446 incident patients with from five PD centers in China between 1 January 2005 and 31 May 2020. Creatine kinase was collected 1 week before the start of PD. We examined the association between creatine kinase and mortality using Cox proportional hazards model.

Results

The median creatine kinase was 113 (range, 1.22-4,574) IU/L. With a median follow-up of 39.5 (range, 3.1-181.5) months, 763 (22.1%) all-cause deaths occurred, including 384 (11.1%) cardiovascular deaths. As compared with a creatine kinase of 111-179 IU/L (reference range), a higher creatine kinase (>179 IU/L) was associated with increased risks of all-cause mortality [hazards ratio (HR), 1.72; 95% CI, 1.35-2.00; E-value = 2.83] and cardiovascular mortality (HR, 1.44; 95% CI, 1.05-1.98; E-value = 2.24). As compared with the reference range, a lower creatine kinase (<111 IU/L) was associated with increased risks of all-cause mortality (HR, 1.40; 95% CI, 1.12-1.76; E-value = 2.15) and cardiovascular mortality (HR, 1.45; 95% CI, 1.08-1.94; E-value = 2.26). Interaction between creatine kinase and no hyperlipidemia (p = 0.034 for interaction) was observed.

Conclusion

A creatine kinase before the start of PD between 111 and 179 IU/L was associated with a lower risk of death than a higher or lower creatine kinase, resulting in a U-shaped association curve.

Clinical and biochemical factors associated with survival in equids attacked by dogs: 28 cases (2008-2016)

Background

Trauma from dog attacks has been associated with mortality rates as high as 23% in some species. However, the prognosis and clinical features of this type of injury have not been described in equids.

Hypotheses/Objectives

To describe survival rate, signalment, clinical features, and biochemical results in equids presented for emergency care after presumed dog attacks. We hypothesized there would be differences between survivors and nonsurvivors.

Animals

A total of 28 equids presented for presumed dog attacks from 3 referral centers.

Methods

A retrospective study was performed using data from 3 hospitals between 2008 and 2016. Survival was defined as survival at 14 days postdischarge. Variables were compared between survivors and nonsurvivors using a t test, Mann‐Whitney U test, or Fisher's exact test as appropriate.

Results

Overall mortality rate was 21%. Ponies and miniature horses represented 16/28 (57%) of the animals in the study. Full‐sized equids had a lower risk of nonsurvival as compared to smaller patients (odds ratio = 0.02; 95% confidence intervals = 0.00‐0.27; P < .005). Animals with lower body temperatures had increased risk for nonsurvival (P = .0004). Increased admission blood lactate concentrations (P = .003) and decreased serum total protein concentrations (P = .006) were associated with nonsurvival.

Conclusions

The mortality rate in equids attacked by dogs was similar to what is reported for other veterinary species. Smaller equids and those with increased admission blood lactate concentration, lower body temperature, and lower total serum protein concentrations were less likely to survive.

Low Serum Creatine Kinase Level Predicts Mortality in Patients with a Chronic Kidney Disease

BACKGROUND

Serum creatine kinase (sCK) reflects CK activity from striated skeletal muscle. Muscle wasting is a risk factor for mortality in patients with chronic kidney disease (CKD). The aim of this study is to evaluate whether sCK is a predictor of mortality and end-stage renal disease (ESRD) in a CKD population.

METHODS

We included 1801 non-dialysis-dependent CKD patients from the NephroTest cohort. We used time-fixed and time-dependent cause-specific Cox models to estimate hazard ratios (HRs) for the risk of death and for the risk of ESRD associated with gender-specific sCK tertiles.

RESULTS

Higher sCK level at baseline was associated with a lower age, a higher body mass index, and a higher level of 24 h urinary creatinine excretion, serum albumin and prealbumin (p<0.001). Men, patients of sub-Saharan ancestry, smokers and statin users also experienced a higher level of sCK. In a time-fixed Cox survival model (median follow-up 6.0 years), the lowest gender-specific sCK tertile was associated with a higher risk of death before and after adjustment for confounders (Crude model: hazard ratio (HR) 1.77 (95% CI: 1.34-2.32) compared to the highest tertile; fully-adjusted model: HR 1.37 (95% CI: 1.02-1.86)). Similar results were obtained with a time-dependent Cox model. The sCK level was not associated with the risk of ESRD.

CONCLUSION

A low level of sCK is associated with an increased risk of death in a CKD population. sCK levels might reflect muscle mass and nutritional status.