Serum creatine phosphokinase as prognostic indicator in the management of electrical burn.

OBJECTIVE: To determine the mean difference of serum creatine phosphokinase according to the extent of tissue damage and prognosis of the patients suffering from electrical burn injuries. STUDY DESIGN: A case series study. PLACE AND DURATION OF STUDY: Department of Burns, Liaquat University Hospital, Hyderabad, from September 2005 to August 2006. PATIENTS AND METHODS: During the study period, 38 patients with electrical burn injuries were enrolled. Victims of electrical burns with evidence of myocardial injury were excluded. Following admission, serum creatine phosphokinase was measured serially on 10 consecutive occasions. The data was later analyzed statistically using SPSS-10.0. RESULTS: Of the 38 patients, the mean age of the victims was 28 years, with males dominating the study population (82%). A statistically significant association was found between the level of serum creatine phosphokinase and likelihood of death (p=0.000). It was also found that serial monitoring of this enzyme can be used as prognostic indicator in the management of electrical burns injury. CONCLUSION: The level of creatine phosphokinase increased with the degree of tissue injuries in patients with electrical burns. This prognostic value is of great importance in the local setup, where sophisticated investigations to detect extent of injuries are not available.

Correlation between serum creatinine kinase levels and extent of muscle damage in electrical burns.

The relationship between clinical course and changes of laboratory findings in patients with high-voltage electrical burns with regard to creatinine kinase activity was analyzed in order to determine the value of this prognostic parameter with regard to patients survival and risk of limb amputation. In a retrospective study 42 patients with electrical burns were reviewed. CK serum levels were determined every day during the first 10 days following submission. Analysis of data revealed a relation between strongly elevated CK levels and patients risk of limb amputation and mortality. Although further research is necessary, there is strong evidence that the amount of burned body surface area does not directly correlate with the true extent of tissue damage caused by high tension injuries. Our data suggest that the degree of muscle tissue violation corresponds with the initial excess of creatinine kinase levels in blood serum. This may be an additional factor to support the decision for early surgical decompression of electrically burned extremities and aggressive surgical management of the high-voltage burn victim. Furthermore, it may provide a prognostic parameter for the clinical outcome of these patients.

[Clinical significance of the change of serum CK-MM in electrical injured patients].

OBJECTIVE: To evaluate the diagnostic value of the changes in serum CK and its isozymes in the muscular infection and necrosis in electrical injured patients. METHODS: Seventeen patients were divided into A and B groups according to the causes, i.e. electrical injury as A and electrical arc flame burn as B groups. Obvious muscle necrosis was identified in A but not in B groups. The serum CK-MM concentration was determined after injury, before and after the operations. Simultaneously, the blood and urine routine, the hepatic and renal function and wound bacterial counting were determined and compared with those in 20 healthy people. RESULTS: 1. The serum CK-MM in A group increased evidently after injury and 1 day after wound debridement to the 6 times that in normal control. The enzyme decreased to normal at 3 post-operative days in 15 cases and remained at relative high level in 2 cases due to the wound infection and lowered down to normal level after wound re-debridement. 2. The serum CK-MM in B group increased slightly before and after skin grafting. CONCLUSION: CK-MM could be employed as the index for the infection and necrosis of the muscle in electrical injured patients due to its high specificity and sensitivity.

[Study on the abnormal gene expression of inducible nitric oxide synthase (iNOS) in rabbit myocardium after high voltage electrical injury].

OBJECTIVE: To elucidate the effects of high voltage electrical injury on the mRNA expression of iNOS And endothelin-1 (ET-1) in rabbit myocardium. METHODS: Rabbits inflicted by high voltage electrical injury were employed as the model. Reverse transcription PCR (RT-PCR) and serum enzyme measurement were used in the detection of the expression levels of iNOS mRNA and ET-1 mRNA of rabbit myocardial tissue and plasma creatine kinase (CK) content. RESULTS: The expression of iNOS mRNA in rabbit myocardial tissue after high voltage electrical injury increased at 6 to 8 postburn hours (PBH) and decreased thereafter. The plasma contents of CK and ET-1 mRNA reached their peak values at 2 PBH. CONCLUSION: The increase of iNOS mRNA might protect myocardial tissue from electrical injury.

Creatine kinase as a prognostic indicator in electrical injury.

Serial serum creatine kinase (CK) and creatine kinase myocardial band isoenzyme (CK-MB) levels were obtained from 116 of 125 electrical burn patients admitted from 1976 through 1986. We divided patients into three groups (peak CK within 2 days after admission) as follows: group 1, CK less than 400 U/L; group 2, CK = 400 to 2500 U/L; group 3, CK greater than 2500 U/L. Clinical myocardial infarction (MI) was determined by ischemic ECG changes, LDH isoenzyme patterns, and clinical course. Skin grafts occurred in 2 of 24 patients from group 1, in 15 of 31 from group 2, and in 37 of 61 from group 3. Hospital stay (mean +/- SEM) was 4.6 +/- 1.3 days for group 1, 20.2 +/- 5.4 for group 2, and 37.7 +/- 3.6 for group 3. Group 1 patients required no amputations; group 2 had 1 limb and 5 digit amputations; group 3 had 22 limb and 16 digit amputations. Only three clinical MIs were found (all in group 3), although 1 of 31 patients from group 2 and 32 of 61 from group 3 had CK-MB greater than 4%. Highly elevated CK and CK-MB are associated with longer hospitalization, and a greater risk of skin grafting or amputation, than with levels less than 400 U/L. Clinical MI is rare and cannot be diagnosed by elevated CK-MB alone.

Creatinine phosphokinase values in electrical and thermal burns.

Twenty-six patients were evaluated with regard to CPK values in week 1 post-burn. Patients were allocated into two groups based on the severity of burn injury. Group 1 included patients with minor electrical or thermal injury, and Group 2 those patients with deep thermal injury and objective evidence of muscle necrosis. With the exception of day 5 post-burn, Group 2 had significantly increased CPK levels as compared to Group 1. This indicates that CPK levels, especially with electrical and deep thermal burns, are sensitive tests in evaluating the depth of burn injury such that an appropriate pre-operative strategy for debriding and grafting is possible.

Myocardial damage and electrical injuries: significance of early elevation of CPK-MB isoenzymes.

Significant cardiac complications among immediate survivors of high-voltage electrical injuries are less common than previously suspected. Transient arrhythmias predominate. The MB isoenzyme of serum creatine phosphokinase may be factitiously elevated within the first 48 hours after injury. In the absence of clinical symptoms or electrocardiographic signs of ischemia, early isolated elevation of this cardiac isoenzyme should not preclude an aggressive surgical approach.

Creatine kinase and lactate dehydrogenase isoenzymes in serum of patients suffering burns, blunt trauma, or myocardial infarction.

Medical records of 53 burn and trauma patients were reviewed to assess the possibility of myocardial damage. Except for electrophoretically detectable creatine kinase MB isoenzyme, none showed evidence of myocardial injury. Lactate dehydrogenase isoenzyme tests, electrocardiograms, myocardial pyrophosphate scans, clinical course, and results of (two) autopsies were all negative for myocardial necrosis or ischemia. Types of patient, number, mean peak value (U/L) for serum creatine kinase, and ranges of percentage MB isoenzyme were as follows. Burns from direct electrical contact: 28, 16 600, 0-29; electrical flash or other thermal burns: 10, 4340, 0-22; blunt trauma (mostly from automobile accidents): 15, 3430, 0-18; myocardial infarction: 57, 1520, 4-46. Evidently creatine kinase MB isoenzyme is nonspecific in burn and trauma patients and should not be the only test result used to assess myocardial involvement.