SavedAdd your journal

Journals / Journal of Anatolian Medical Research / 2018 / Cilt: 3 Sayı: 3

Analysis of the Patients with Elevated Creatinine Kinase (CK) Level at Emergency Department

Acil Serviste Kreatinin Kinaz (CK) Yüksekliği Saptanan Hastaların Analizi

Yavuz Aydın(T.C. Sağlık Bakanlığı, İstanbul Silivri Devlet Hastanesi, Acil Servis)
Fatih Çakmak(İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Acil Tıp Anabilim Dalı)
Yonca Senem Akdeniz(İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Acil Tıp Anabilim Dalı)
Afşın İpekci(İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Acil Tıp Anabilim Dalı)
Sevil Kuşku Kıyak(T.C. Sağlık Bakanlığı, İzmir Buca Seyfi Demirsoy Devlet Hastanesi, Acil Servis)
Mustafa Öztürk(Sağlık Bilimleri Üniversitesi, İstanbul Haseki Eğitim Ve Araştırma Hastanesi, Acil Tıp Kliniği)
İbrahim İkizceli(İstanbul Üniversitesi-Cerrahpaşa, Cerrahpaşa Tıp Fakültesi, Acil Tıp Anabilim Dalı)
Pages
1–24
Publication Date
2018-12-06
DOI
—
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conclusion: Among the patients who admitted to the Emergency Department, CK height is mostly seen at cardiovasculer system disorders, and dependent of this, the chest pain is most commonly seen complaint in patients with elevated CK levels.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: The aim of this study was to analyse the clinical conditions and the causes of the CK elevation of the patients with elevated CK level at emergency department.
📊
Key Findings & Data:Material and Method: This clinical study was conducted on a group of 118 patients admitted to emergency department with several clinical conditions and whose CK level is elevated, during six months between January and June.
💡
Conclusion & Impact:Conclusion: Among the patients who admitted to the Emergency Department, CK height is mostly seen at cardiovasculer system disorders, and dependent of this, the chest pain is most commonly seen complaint in patients with elevated CK levels.
🔬Design:Araştırma Makalesi
📍Scope:Comprehensive Sample
⚙️Variables:Acil Servis · Kreatinin Kinaz · Rabdomiyoliz.

Abstract

Objective: The aim of this study was to analyse the clinical conditions and the causes of the CK elevation of the patients with elevated CK level at emergency department. Material and Method: This clinical study was conducted on a group of 118 patients admitted to emergency department with several clinical conditions and whose CK level is elevated, during six months between January and June. Claim of CK from patients was performed by the phsician who work at the Emergency Department and request of indication was not questioned. The age, gender, clinical conditions, history, drugs used and the exact diagnosis of the patients are gathered in a form previously prepared . Patients with high CK level was divided into 3 groups. Results were analysed stastistically. Results: Kreatin Kinaz elevation was found on % 66,1 (n=78) male patients, % 33,9 (n=40) female patients respectively. CK levels were between 203 and 6274. Mean CK level was 812,17±975,45 and median CK level was 417. According to the clinical findings, we have found that ; with a rate of 29,7 % chest pain was most commonly seen. According to the diagnosis; acute coronary syndromes (ACS) ( 24,6 %) was most commonly seen, fallowed by infections (16,1 %) and drugs (13,6 %). Accordig to the drugs the most common drugs which caused CK elevation was beta blokers, fallowed by statins and diuretics. Conclusion: Among the patients who admitted to the Emergency Department, CK height is mostly seen at cardiovasculer system disorders, and dependent of this, the chest pain is most commonly seen complaint in patients with elevated CK levels.

Özet

Amaç: Acil Servise başvuran ve CK yüksekliği tespit edilen hastaların geliş şikâyetlerini ve CK yüksekliği yapan nedenleri tespit etmeyi amaçladık. Materyal ve Metod: Bu klinik çalışma, Ocak ve Haziran ayları arasında altı ay boyunca çeşitli şikâyetlerle acil servisimize başvuran ve yapılan ilk rutin tetkikleri neticesinde CK yüksekliği saptanan 118 hasta ile yapıldı. Hastalardan CK tetkikinin istemi acil serviste çalışan doktorun isteği doğrultusunda gerçekleşti ve CK istem endikasyonu sorgulanmadı. CK değerleri yüksek olan 118 hastanın yaşı, cinsiyeti, şikâyeti, öz geçmişi, kullandığı ilaçları ve kesin tanılarını içeren bilgiler ayrı olarak hazırlanmış formda toplandı. CK yüksekliği saptanan hastalar 3 gruba ayrıldı. Elde edilen sonuçlar istatistiksel olarak değerlendirildi. Bulgular: Hastaların % 66,1’i erkek, % 33,9’u kadındı. CK değerleri 203 ile 6274 arasında değişmekte olup ortalama CK değeri 812,17±975,45 olarak saptandı; medyan değeri ise 417 olarak bulundu. Olguların şikâyetleri incelendiğinde; %29,7 oran ile göğüs ağrısı ve göğüste sıkışma hissi en sık olarak tespit edildi. CK yüksekliği nedenlerine baktığımızda ilk sırada %24,6 ile AKS (Akut Koroner Sendromlar), sonrasında %16,1 ile enfeksiyon ve %13,6 ile ilaç kullanımı geldiği tespit edildi. Çalışmamızda CK yükselmesi yapan ilaçları incelediğimizde birinci sırada beta blokörlerin olduğu, bunu sırası ile statinler ve diüretiklerin izlediği tespit edildi. Sonuç: Acil Servise başvuran hastalar arasında serum CK yüksekliği en fazla kardiyovasküler sistem hastalıklarında görülmektedir. Buna bağlı olarak da CK yüksekliği olan hastalarda en sık şikâyet göğüs ağrısı olarak karşımıza çıkmaktadır.

🔖

Cite This Article

Aydın, Y., Çakmak, F., Akdeniz, Y. S., İpekci, A., Kıyak, S. K., Öztürk, M., İkizceli, İ. (2018). Analysis of the Patients with Elevated Creatinine Kinase (CK) Level at Emergency Department. Journal of Anatolian Medical Research, Cilt: 3 Sayı: 3, 1–24. https://ajindex.com/articles/1505459

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (59)

  1. Antman EM, Braunwald E. Acute myocardial infarction İn Heart Disease, Braunwald E. ATextbook of Cardiovascular Medicine.5th ed. Philadelphia: W.B.Saunders; 1997:1184-1268.
  2. Roberts R, Henry PD, Witteven S et all. Quantification of serum creatine phosphokinase izoenzyme activity. Am J Cardiol 1974; 33: 350-54.
  3. Counselman L. Francis, Lo M. Bruce. Rabdomyolysis. in Judith E. Tintinalli,Gabor D. Kelen,J. Stephan Stapczynski. Acil Tıp. 5th. İstanbul: Nobel Tıp Kitabevleri; 2013: 622-624.
  4. B Ercan, L Tamer, U Atik. Kreatin Kinaz İzoenzimleri ve klinik önemleri. Mersin Üniversitesi Tıp Fakültesi Dergisi 2003; 3: 236-245.
  5. Eckstein Mark, Henderson O. Sean. Thoracic Trauma. İn Marx, Hochberger, Walls. Rosen’s Emergency Medicine 7.th Edition. Philadelphia: Mosby; 2010: 387-414.
  6. Gürger Mehtap, Bozdemir Mehmet Nuri, Yıldız Mustafa ve ark. Acil Servise İskemik İnme Nedeniyle Başvuran Hastalarda Hastane İçi Mortalitenin Belirlenmesinde Kardiyak Belirteçlerin Rolü. Türkiye Acil Tıp Dergisi 2008; 8: 59-66.
  7. Bontempo J. Laura, Kaji H. Amy. Rabdomyolysis. İn Marx, Hochberger, Walls. Rosen’s Emergency Medicine 7.th Edition. Philadelphia: Mosby; 2010: 1650-1658.
  8. Chalidis BE, Kalivas E, Parziali M et al. Cuff width increases the serum biochemical markers of tourniquet induced skeletal muscle ischemia in rabbits. Orthopedics 2012; 35: 1245-1250.
  9. Borges O, Essen-Gustavsson B. Enzyme activities in type I and II muscle fibres of human skeletal muscle in relation to age and torque development. Acta Physiol Scand 1989; 136: 29–36.
  10. Tietz NW, Shuey DF, Wekstein DR. Laboratory values in fit aging individuals- sexagenarians though centenarians. Clin Chem 1992; 38: 1167–1185.
  11. Amelink GJ, Kamp HH, Bar PR. Creatine kinase isoenzyme profiles after exercise in the rat: sex-linked differences in leakage of CKMM. Pflugers Arch 1988; 412: 417–421.
  12. Tiidus PM. Estrogen and gender effects on muscle damage, inflammation and oxidative stress. Can J Appl Physiol 2000; 25: 274–287.
  13. Amelink GJ, Koot RW, Erich WB et al. Sex-linked variation in creatine kinase release, and its dependence on oestradiol, can be demonstrated in an in vitro rat skeletal muscle preparation. Acta Physiol Scand 1990; 138: 115–124.
  14. Kost GJ, Kirk JD, Omand K. A strategy for the use of cardiac injury markers (troponin I and T, creatine kinase-MB mass and isoforms, and myoglobin) in the diagnosis of acute myocardial infarction. Arch Pathol Lab Med 1998; 122: 245-51.
  15. Hetland O, Dickstein K. Cardiac markers in the early hours of acute myocardial infarction: clinical performance of creatine kinase, creatine kinase MB isoenzyme (activity and mass concentration), creatine kinase MM and MB subform ratios, myoglobin and cardiac troponin T. Scand J Clin Lab Invest 1996; 56: 701-713.
  16. Chang CC, Ip MP, Hsu RM et al. Evaluation of a proposed panel of cardiac markers for the diagnosis of acute myocardial infarction in patients with atraumatic chest pain. Arch Pathol Lab Med 1998; 122: 320-324.
  17. Omrani AS, Matin MA, Haddad Q et al. A family cluster of Middle East Respiratory Syndrome Coronavirus infections related to a likely unrecognized asymptomatic or mild case.Int J Infect Dis 2013; 17: 668-672.
  18. Durgut R, Ataseven VS, Sağkan Öztürk A et al. Evaluation of total oxidative stress and total antioxidant status in cows with natural bovine herpesvirus-1 infection.J Anim Sci 2013; 91: 3408-3412.
  19. Costa MM, França RT, Da Silva A et al. Rangelia vitalii: changes in the enzymes ALT, CK and AST during the acute phase of experimental infection in dogs. Rev Bras Parasitol Vet 2012; 21: 243-248.
  20. Takahashi T., A case of primary human immunodeficiency virus infection with severe rhabdomyolysis without acute renal failure. Kansenshogaku Zasshi 2011; 85: 268-271.
  21. Wang C, Yu H, Horby PW et al. Comparison of patients hospitalized with influenza A H7N9, H5N1, and 2009 pandemic H1N1. Clin Infect Dis 2014: 31. 22. Naseem A, Satti S, Khan MA et al. A clinical account of hospitalized 2009 pandemic influenza A (H1N1) cases.J Coll Physicians Surg Pak 2011; 21: 97-102.
  22. Graham DJ, Staffa JA, Shatin D et al. Incidence of hospitalized rhabdomyolysis in patients treated with lipid lowering drugs. JAMA 2004; 292: 2585-2590.
  23. Bowyer SL, LaMothe MP, Hollister JR. Steroid myopathy: Incidence and detection in a population with asthma. J Allergy Clin Immunol 1985; 76: 234-242.
  24. Gill JS, Beevers DG. Bucindolol: effects on blood pressure, airways resistance and serum creatine phosphokinase. Eur J Clin Pharmacol 1984; 27: 265-268.
  25. Kiernan Matthew C, Bullpitt Peter, Chan H.L. Jane.Mitochondrial dysfunction and rod-like lesions associated with administration of β2 adrenoceptor agonist formoterol. Neuromuscular Disorders 2004; 14: 375-377.
  26. Wexler BC. Furosemide-induced hyperuricemia, hyperglycemia, hypertension and arterial lesions in nonarteriosclerotic and arteriosclerotic rats. Atherosclerosis 1981; 39: 253-66.
  27. Wu ZJ, Yu J, Fang QJ et al. Sodium Ferulate Protects against Daunorubicin Induced Cardiotoxicity by Inhibition of Mitochondrial Apoptosis in Juvenile Rats. J Cardiovasc Pharmacol. 2013; 61: 240-249.
  28. Adenis A, Bouché O, Bertucci F et al. Serum creatine kinase increase in patients treated with tyrosine kinase inhibitors for solid tumors. Med Oncol. 2012: Dec;29-33.
  29. Yücel Orhan, Sapmaz Ersin, Çaylak Hasan et al. Analysis of 748 patients with thoracic trauma requiring hospitalization. Gulhane Med J 2009; 51: 86-90.
  30. Rosedale KJ, Wood D, Traumatic rhabdomyolysis (crush syndrome) in the rural setting.S Afr Med J 2011; 102: 37-39.
  31. Poznanović MR, Sulen N., Crush syndrome in severe trauma. Lijec Vjesn 2007; 129: 142-144.
  32. Sanai T, Yokoyama M, Murata A et al. Rhabdomyolysis and unilateral renal infarction after a motor vehicle crash.Angiology 2007; 58: 487-90.
  33. Bhavsar P, Rathod KJ, Rathod D et al. Utility of Serum Creatinine, Creatine Kinase and Urinary Myoglobin in Detecting Acute Renal Failure due to Rhabdomyolysis in Trauma and Electrical Burns Patients.Indian J Surg 2013; 75: 17-21.
  34. Ender Topal A, Nesimi Eren M, Celik Y. Management of non traumatic acute limb ischemia and predictors of outcome in 270 thrombembolectomy cases. Int Angiol 2011; 30: 172-80.
  35. Ege T, Us MH, Sungun M et al.Cytokine response in lower extremity ischaemia reperfusion. J Int Med Res 2004; 32: 124-31.
  36. Brüning CA, Prigol M, Luchese C et al. Protective effect of diphenyl diselenide on ischemia and reperfusion-induced cerebral injury: involvement of oxidative stress and pro-inflammatory cytokines. Neurochem Res 2012; 37: 2249-2258.
  37. Brumback RA, Staton RD, Susag ME. Exercise-induced pain, stiffness, and tubular aggregation in skeletal muscle. J Neurol Neurosurg Psychiatry 1981; 44: 250-254.
  38. Koutedakis Y, Raafat A, Sharp NC et al. Serum enzyme activities in individuals with different levels of physical fitness. J Sports Med Phys Fitness 1993; 33: 252-257.
  39. Bolayır Ertuğrul, Kuğu Nesim, Akyüz Aytekin ve ark. The Role of Muscle Enzymes and Prolactine in the Differentiation between Generalized Tonic Clonic Epileptic Seizures and Nonepileptic Seizures.Epilepsi 2001; 7: 81-83.
  40. Wyllie E, Lueders H, Pippenger C et al. Postictal serum creatine kinase in the diagnosis of seizure disorders. Arch Neurol 1985; 42: 123-6.
  41. Gupta P, Singh VP, Chatterjee S et al. Acute renal failure resulting from rhabdomyolysis following a seizure. Singapore Med J. 2010; 51: 79-80.
  42. Winocour PH, Waise A, Young G et al.Severe, self limiting lactic acidosis and rhabdomyolysis accompanying convulsions. Postgrad Med J 1989; 65: 321-322.
  43. Chodorowski Z, Sein Anand J, Kujawska H et al. Clinical aspects of acute intoxication with ethanol. Przegl Lek 2004; 61: 314-316.
  44. Antoon W. James, Chakraborti Chayan,Corticosteroids in the treatment of alcohol-induced rabdomyolysis.Mayo Clin Proc 2011; 86: 1005-1007.
  45. Aslan Şahin, Erol Mustafa Kemal, Karcıoğlu Özgür ve ark. Karbon monoksit zehirlenmeli hastalarda iskemik miyokardiyal hasarın araştırılması. Anadolu Kardiyol Derg 2005; 5: 189-193.
  46. Miller JAL. Statins challenges and provocations. Curr Opin Neuol 2005; 18: 494–496.
  47. Henry CR, Satran D, Lindgren B et al. Myocardial injury and long-term mortality following moderate to severe carbon monoxide poisoning. JAMA 2006; 295: 398-402.
  48. Kao HK, Lien TC, Kou YR et al. Assessment of myocardial injury in the emergency department independently predicts the short-term poor outcome in patients with severe carbon monoxide poisoning receiving mechanical ventilation and hyperbaric oxygen therapy. Pulm Pharmacol Ther 2009; 22: 473-477.
  49. Silvestrini M, Rizzato B, Placidi F et al. Carotid artery wall thickness in patients with obstructive sleep apnea syndrome. Stroke 2002; 33: 1782-1785.
  50. Bounhoure JP, Galinier M, Didier A et al. Sleep apnea syndromes and cardiovascular disease Bull Acad Natl Med 2005; 189: 445-459.
  51. Aboyans V, Lacroix P, Virot Pet al. Sleep apnoea syndrome and the extent of atherosclerotic lesions in middle-aged men with myocardial infarction. Int Angiol 1999; 18: 70-73.
  52. Hira HS, Kaur A, Shukla A. Acute neuromuscular weakness associated with dengue infection. J Neurosci Rural Pract 2012; 3: 36-39.
  53. Fujii K, Moriya Y, Fujita S et al. Dermatomyositis accompanied by rectal cancer: report of a case. Surg Today 2000; 30: 302-4.
  54. Dourmishev LA, Popov JM, Rusinova D et al.Paraneoplastic dermatomyositis associated with testicular cancer: a case report and literature review. Acta Dermatovenerol Alp Panonica Adriat 2010; 19: 39-43.
  55. Safioleas M, Stamatakos MK, Mouzopoulos GJ et al. Changes of CPK and CPK-MB levels after open and laparoscopic cholecystectomy. Chirurgia (Bucur) 2006; 101: 401-405.
  56. Kaar TK, O'Brien M, Duggan PF et al. Perioperative creatine phosphokinase trends in elderly patients with hip fracture. Ir J Med Sci 1994; 163: 126-127.
  57. Ahrenholz DH, Schubert W, Solem LD. Creatine kinase as a prognostic indicator in electrical injury. Surgery 1988; 104: 741-747.
  58. Tanrıkulu Ceren Ş., Tanrıkul Yusuf, Karaman Serhat. Acil Servis Başvurularının ve Acil Servisten Yatırılan Hastaların Gözden Geçirilmesi. J Clin Anal Med 2014; 5: 128-132.
  59. Graham DJ, Staffa JA, Shatin D et al. Incidence of hospitalized rhabdomyolysis in patients treated with lipid lowering drugs. JAMA 2004; 292: 2585-2590.