Elevation of serum creatine phosphokinase in hospitalized patients.

BACKGROUND: The clinical characteristics and outcomes of patients with significant noncardiac and cardiac serum creatine phosphokinase (CPK) elevations are not well described. METHODS: One hundred fifty-eight inpatients who had CPK elevation of >1000 IU/L were identified. One hundred thirty-seven patients whose CPK elevations could be attributed to either noncardiac or cardiac etiologies were included and analyzed for clinical characteristics, 30-day, 3-month, and 1-year all-cause mortality rates. Twenty-one patients were excluded, in whom noncardiac and cardiac CPK (CCPK) elevations coexisted, or etiologies were unclear. RESULTS: Of the 137 patients, 43 (31%) patients had CCPK elevation and 94 (69%) patients had noncardiac CPK (NCCPK) elevation. One-year mortality rate was 26.6% (25 of 94 patients) in NCCPK elevation group. Decedents were older (P < 0.05), had higher blood urea nitrogen (P < 0.01) and creatinine (P < 0.05) levels, and had higher white blood cell counts (P < 0.05) compared with survivors. In CCPK elevation group, 37.2% (16 of 43 patients) died within 1 year after admission. Decedents were also older (P < 0.01) and had higher blood urea nitrogen (P < 0.01) and creatinine (P < 0.01) levels. CONCLUSION: The incidence of NCCPK elevation is greater than that of CCPK elevation in a veteran, mostly male, population. One-year mortality rate in patients with NCCPK elevation is comparable to that in patients with CCPK elevation (26.6% versus 37.2%, P = 0.290). Age and renal insufficiency are 2 major predictors for increased mortality in both groups.

New onset atrial fibrillation developing in medical inpatients.

BACKGROUND: The outcome of patients who develop new onset atrial fibrillation (AF) after admission to an Internal Medicine service for acute medical illnesses is unknown. METHODS: In a retrospective review, we compared patients in the study group: patients who were admitted to hospital for acute medical illnesses and subsequently developed new onset AF during hospitalization, with a control group 1: patients whose admitting diagnosis was new onset AF and a control group 2: patients who were admitted for acute medical illnesses and never developed AF. We analyzed clinical characteristics and all-cause mortality rate during the first 30 days, 6 months, and 1 year after admission. RESULTS: The 1-year mortality rates in study group were significantly higher than control group 1 (62% versus 8%, P < 0.001) and control group 2 (62% versus 29%, P < 0.05). These results suggest that AF and acute medical illness both are risk factors for increased mortality. The odds ratios were 4.05 (P = 0.023) and 18.33 (P = 0.001) for AF and acute medical illnesses, respectively, indicating that acute medical illness is the better predictor for mortality. Troponin I levels were elevated in 46% of patients in study group versus 12% in control group 1 and 42% in control group 2 (P < 0.05). CONCLUSIONS: Medical inpatients who develop new onset AF during hospitalization for acute medical illnesses have an increased mortality when compared with patients who were admitted solely for new onset AF. Acute medical illness rather than AF plays a more important role on the increased mortality in this subset of patient population.

Tongue discoloration in an elderly kidney transplant recipient: Treatment-related adverse event?

BACKGROUND: With the increased occurrence of methicillin-resistant staphylococcus aureus infections, linezolid treatment might be administered more often. New rare adverse events are likely to follow. CASE SUMMARY: A 65-year-old man (weight, 91 kg; height, 185 cm) presented to the emergency department at the University of Virginia-affiliated Salem Veterans Affairs Medical Center, Salem, Virginia, after a recent (8 weeks) kidney transplantation with a 24-hour history of fatigue, chills, arthralgias, increased urinary frequency, and onset of tongue discoloration. Two days before admission, he completed a 14-day course of linezolid 600 mg PO BID for ampicillin-resistant enterococcal urinary tract infection. He was afebrile on admission and the dorsal aspect of his tongue was blackened centrally, browner peripherally, with normal pink mucosa on the periphery. Based on the Naranjo probability scale, the calculated score for tongue discoloration as a drug-related adverse event was 7 out of a maximum score of 13 points, designating it as a probable cause. The patient's tongue discoloration improved moderately during the hospital stay and resolved 6 months after the discontinuation of linezolid. CONCLUSIONS: We report a rare association of linezolid and tongue discoloration in an elderly kidney transplant recipient that improved with discontinuation. We present this case to increase clinicians' awareness of the potential adverse event.