Significance of Creatine Kinase Isoenzymes for Neurologic Outcome in Perinatal Asphyxia

PURPOSE: To investigate the usefulness of the serum Creatine kinase(CK), especially brain typical creatine kinase(CK-BB) as an indicator of brain damage extent, mortality and long term nurologic sequelae, the study was done. METHODS: CK and CK isoenzyme activites were measured at 6-10 hours after birth in 160 asphyxiated newborn infants who admitted in Eulji General Hospital from August 1990 to July 1994. Infants were followed up for 1 years after birth to evaluate survival and neurologic outcome. RESULTS: 1) There was low correlation between CK-BB and 5 minute Apgar score(r=0.245, p=0.0026). 2) There was intermediate correlation between CK-BB and Lactic dehydrogenase (LDH)(r=0.470, p<0.0001). 3) Infants who died within 24 hours after birth had significantly higher CK-BB activity(144.9+/-98.5U/L) than survivors(82.2+/-159U/L), (p=0.0160). Infants who died within 72 hours after birth had significantly higher CK-BB activity(130.2+/-108.4U/L) than survivors(80.5+/-161.1U/L), (p=0.0209) 4) Infants who died within 24 hours after birth had significantly higher CK-BB%(23.4+/-17.4%) than survivors(9.6+/-11.9%), (p=0.0042). Infants who died within 72 hours after birth had significantly higher CK-BB%(20.0+/-15.4%) than survivors(9.3+/-11.8%), (p= 0.0027). Infants who died within 28 days after birth had significantly higher CK-BB% (12.7+/-13.4%) than survivors(9.7+/-12.3%), (p=0.0500). 5) In the cases of neonatal seizure in 24-48 hours after birth, CK-BB was higher than in the cases of no seizure or seizure in 48 hours after birth. 6) CK-BB was well correlated to the grade of hypoxic ischemic encephalopathy. 7) CK-BB, CK-BB% and 5 minute Apgar score showed similar positive and negative predictive values for survival rate, abnormal findings of imaging studies and neurologic outcomes. CONCLUSIONS: CK-BB is a good predictive value for the death within 24 and 72 hours after birth and the neonatal seizure in 24-48 hours after birth. CK-BB% is a good predictive value of the death within 24, 72 hours and 28 days after birth. CK-BB, CK-BB% and 5 minute Apgar score showed similar predictivity for neurologic outcomes during 1 years after birth.

The Clinical Analysis of Alcohol and Creatine Kinase-BB(CK-BB) in Acute Head Injury

Patients suffering a head-injury were often drinking alcohol shortly before the trauma, and it has been suggested that the degree of brain damage may be exacerbated due to high alcohol serum levels. To evaluate this, we assessed the level of consciousness, alcohol and creatinine kinase-bb(CK-BB) serum levels in 140 consecutive head-injured patients. Level of consciousness(GCS score) was strongly correlated to outcome(p<0.001) and serum CK-BB(P<0.05), but not to alcohol serum levels.

The Clinical Analysis of Serum Creatine Kinase BB(CK-BB) in Acute Head Injury Patients

The extent of brain damage is known to be an essential predictive factor in the clinical course of patient with severe head injury. The purpose of the work was to study the usefulness of brain type creatine kinase(CK-BB) as a iochemical index of brain injury. We performed a Tri-check isoenzyme electrophoresis to determine the serum level of CK-BB in 123 patients with head injury. CK-BB isoenzyme was detected in the serum in 24 out of 123 patients with acute brain injury(19.5%). The peak of CK-BB activity ranged from 2 to 85IU/1 and mean value was 21.40+/-21.66IU/1. The activity was higher in patients with diffuse axonal injury, intracerebral hematoma and subdural hematoma than any other cases. The serum CK-BB isoenzyme was more frequently detected in low GCS score cases at admission and these patients had poor outcome than high GCS score cases. High CK-BB activity in serum was associated with poor prognosis, but a low CK-BB activity in serum was not necessarily a good prognostic sign. The presence of the serum CK-BB isoenzyme correlated with admission GCS score and with the ultimate outcome. We conclude that CK-BB level in serum is a reliable marker of cerebral parenchymal injury and may enhance the predictive value of the Glasgow coma scale score when used in conjunction with this indicant.

The Clinical Analysis of Serum Creatine Kinase BB(CK-BB) in Acute Head Injury Patients

The extent of brain damage is known to be an essential predictive factor in the clinical course of patient with severe head injury. The purpose of the work was to study the usefulness of brain type creatine kinase(CK-BB) as a iochemical index of brain injury. We performed a Tri-check isoenzyme electrophoresis to determine the serum level of CK-BB in 123 patients with head injury. CK-BB isoenzyme was detected in the serum in 24 out of 123 patients with acute brain injury(19.5%). The peak of CK-BB activity ranged from 2 to 85IU/1 and mean value was 21.40+/-21.66IU/1. The activity was higher in patients with diffuse axonal injury, intracerebral hematoma and subdural hematoma than any other cases. The serum CK-BB isoenzyme was more frequently detected in low GCS score cases at admission and these patients had poor outcome than high GCS score cases. High CK-BB activity in serum was associated with poor prognosis, but a low CK-BB activity in serum was not necessarily a good prognostic sign. The presence of the serum CK-BB isoenzyme correlated with admission GCS score and with the ultimate outcome. We conclude that CK-BB level in serum is a reliable marker of cerebral parenchymal injury and may enhance the predictive value of the Glasgow coma scale score when used in conjunction with this indicant.

The Clinical Significance of Serum Creatine Kinase-BB(CK-BB) in Acute Head Injury

Serial enzymatic determinations by electrophoresis were confined in serum of CK-BB(creatine kinase brain fraction), which were performed on 150 patients with acute head injury. The purpose of this study was to re-evaluate the usefulness of this serum enzyme value as a prognostic correlates. The results obtained are as follows : 1) 125 cases(83.3%) among 150 cases with head injury were revealed as CK-BB positive finding, whereas 25 cases (16.7%) with negative results have generally good outcome. 2) 3 cases (11.5%) of false positive finding were shown among 26 control group with back pain. 3) The maximum value of CK-BB(CK-BBmax) was een within 1st day(38.4%), and 3rd days (80.8%) following injury. 4) The appearance of mean CK-BBmax had two varieties of peak incidence on 1st-and 4th day following injury. 5) The Glasgow Coma Scale(GCS) Score on admission had close relationship to the value of inital CK-BB(CK-BBin) and CK-BBmax, respectively (P or =1 IU.L) to outcome (P or =1 IU/L) to outcome did not (P=0.126). 8) The Glasgow Outcoem Scale (GOS) was strongly correlated to mean GCS Score (P<0.000) and mean CK-BBin (P<0.000), but not to mean CK-BBmzs (P<0.139). 9) The correlationship between mean value of CK-BBin and CK-BBmax was statistically significant only in good recovery and moderate disability group, respectively (P<0.000 & P<0.003).