Low serum creatine kinase activity in hospital patients

doi:10.1080/09674845.2015.11665753

Paper

Low serum creatine kinase activity in hospital patients

Published Jan 1, 2015 · L. Cobbold, R. Curd, M. Crook

British Journal of Biomedical Science

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Abstract

Creatine kinase (CK), an intracellular mitochondrial enzyme present in skeletal and cardiac muscle as well as brain tissue, is responsible for the conversion of creatine to creatine phosphate. This reaction utilises ATP and produces ADP in a reaction that can also be reversed to produce ATP. Creatine phosphate is therefore an important energy reserve in muscle tissues. High plasma CK activities are seen in muscle cell necrosis, inflammation or trauma such as seen in polymyositis, hypothyroidism, extreme exercise and rhabdomyolysis.1 Low activities of serum CK have earlier been reported in some patients in various short reports in the medical literature.2–4 However, we wanted to explore the phenomenon of low serum CK activity in a large hospital and general practice population and also relate this to patient outcome such as mortality and length of bed stay. This study was designed to identify patients tested and treated at a large district general hospital who had subnormal serum CK activities. The frequency of this phenomenon was investigated as well as the potential causes of the low serum CK activities. Understanding the causes for reduced serum CK activity may help the laboratory interpretation of such results. The serum CK results from patients tested in the biochemistry department of our hospital between 1 October 2012 and 30 September 2013 were examined and any results below 26 IU/L (laboratory reference range 26–180 IU/L) were recorded. Patients with a serum CK result of below 20 IU/L were examined further as this is the lower limit of the lowest reference range reported in the medical literature.5 Details collected from each patient with a low serum CK activity included age, clinical details, gender and clinical location. Serum CK was analysed on an Abbott Architect analyser with coefficient of variation (CV%) <5%. As quoted by the manufacturer the assay for CK catalyses the transfer of a high energy phosphate group from creatine phosphate to ADP. The ATP produced in this reaction is subsequently used to phosphorylate glucose to produce glucose-6-phosphate (G-6-P) in the presence of hexokinase. G-6-P is then oxidised by glucose-6-phosphate dehydrogenase with the concomitant reduction of nicotinamide adenine dinucleotide phosphate (NADP) to nicotinamide adenine dinucleotide phosphate reduced (NADPH). The rate of formation of NADPH is monitored at 340 nm and is proportional to the activity of CK in the sample. These reactions occur in the presence of N-acetyl-L-cysteine which is present as an enzyme reactivator. From the laboratory clinical records we determined the causes of reduced serum CK activities and identified patient populations likely to show such results. Data were collected on a Telepath Pathology patient management system. The clinical audit office of our hospital approved this project (Project Number 2729). Ethical committee approval was not required as this was a retrospective observational study. Data were analysed using Microsoft EXCEL statistics software; statistical significance was taken as P<0.05. During the year under investigation, a total of 1422 (6.8% of all CK requests received) samples from 329 patients (3.6%) with a serum CK activity below 26 IU/L were received in the laboratory. 929 (4.2%) samples from 195 (2.2%) patients had a serum CK result of below 20 IU/L. 157 (0.8% of all samples received) samples had a serum CK result below 10 IU/L. 421 samples (2%) had a serum CK between 10 and 15 IU/L. 350 (1.7 %) samples had a serum CK activity between 16 and 19 IU/L. The vast majority of patients with a serum CK activity below 20 IU/L were elderly above the age of 75 years (Table 1). There was a significantly higher frequency of females than males with a low serum CK activity result (below 20 IU/L; P<0.05). A total of 121 females had a serum CK result of <20 IU/L but only 74 males. The vast majority of patients with low serum CK activity were from acute wards in the hospital (Table 2). The most common locations were the intensive care unit (ITU) and the high dependency unit (HDU). The association of a low serum CK activity with critical locations in the hospital indicates the potentially serious nature of this biochemical phenomenon. For this reason, the number of patients who had died during their hospital stay in which a low serum CK activity (<20 IU/L) was recorded was investigated. The results showed that 16% of patients had died during their hospital stay. A low serum CK activity was shown to be associated with a prolonged hospital stay (Table 3). The majority of patients with a serum CK activity value <20 IU/L had a hospital stay of between two weeks and three months. The clinical details of patients with a serum CK activity below 20 IU/L were available for 66 patients. The potential

Observational Study

Study Snapshot

Low serum creatine kinase activity is common in hospital patients and may indicate underlying health issues.

PopulationOlder adults (50-71 years)

Sample size24

MethodsObservational

OutcomesBody Mass Index projections

ResultsSocial networks mitigate obesity in older groups.

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Low serum creatine kinase activity in hospital patients

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