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Eastern Regional Meeting - 2008 Program & Abstracts
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ELEVATION OF SERUM CREATINE PHOSPHOKINASE IN MEDICAL INPATIENTS
S.X. Chen, K. Amir, R. Bobba, E. Arsura, Medicine, Richmond University Medical Center, Staten Island, NY
Purpose of Study: Elevated serum creatine phosphokinase (CPK), related either skeletal muscle or myocardial injury, is a relatively common clinical finding in medical inpatients. A number of studies have focused on various etiologies of the CPK elevation. However, the clinical characteristics and outcomes of patients with cardiac or non-cardiac CPK elevations are not well described.
Methods Used: A retrospective study that compared the clinical characteristics and outcomes of patients at a Veterans Affairs Medical Center who had either cardiac or non-cardiac CPK elevation >1000 u/l. In 143 patients there was confidence that CPK elevations could be attributed to either cardiac or non-cardiac etiologies. We evaluated patient’s age, cardiac enzymes, renal function, white blood cell count and other clinical characteristics in addition to 30-day and one-year mortality. Two-sample unpaired t-test was used for statistical analysis.
Summary of Results: Of the 143 patients, 43 (30%) patients had cardiac CPK elevation. 100 (70%) patients had non-cardiac CPK elevation related to falls (29.3%), postoperative state (8.4%), severe infection (5.3%), alcohol abuse (4.4%), medication-induced (4.4%), and other etiologies. One-year mortality was 37.2% and 28% respectively for patients with cardiac and non-cardiac CPK elevation. 81.3% of deceased patients who had cardiac CPK elevation expired within 30 days of admission, while 42.9% of deceased patients with non-cardiac CPK elevation died within 30 days. A comparison of the clinical characteristics of decedents to survivors in the cardiac CPK elevation group revealed that age (p<0.01) and elevated serum creatinine (p<0.01) were the major factors related to one-year mortality. In non-cardiac CPK elevation group, age (p<0.05) and elevated serum creatinine (p<0.05) were factors associated with increased mortality. White blood cells count elevation (p<0.05) was also a factor associated with mortality in non-cardiac CPK elevation group.
Conclusions: In medical inpatients, CPK elevation is mostly induced by non-cardiac causes, such as falls, postoperative state, infections and alcohol abuse. The one-year mortality rate in the non-cardiac CPK elevation group is comparable to that in the cardiac CPK elevation group (28% vs. 37.2%). Age and elevated serum creatinine are two major factors associated with mortality in both groups.
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