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CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients

CK/CK-MB Ratio als ein indirekter Parameter für das Überleben von Polytrauma – Patienten

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Summary

Background

Accurate assessment of injury severity is critical for decision making related to the prevention, triage, and treatment of several injured patients. Early estimation of mortality risk of critically injured patients is mandatory for adequate therapeutic strategies. Current risk stratification relies on clinical diagnosis and scoring systems. In our study, we hypothesized whether a simple laboratory test, the CK/CK-MB ratio, could help improving risk prediction in severely traumatized patients.

Methods

In a 9-year period, 328 nonselected trauma patients were included in our retrospective study at a Level I Trauma Center up to September 2002. Data for this study were obtained from our computerized trauma database, established in September 1992.

Results

In our study population, we could show a negative correlation between Injury Severity Score (ISS) and leukocytes. A positive correlation was detected for liver enzymes and CK-MB. The correlation between ISS and Na+ was significant. No correlation between ISS, K+, and Hb/Ht could be observed. Exitus was associated with ISS, alteration in thrombocytes, CK, CK-MB, CRP, Crea, and Na+.

Conclusion

In our study population, CK-MB levels showed a significant correlation with overall surveillance in polytraumatized patients. In our opinion, this might suggest that CK-MB levels could be taken as an indirect predictor for survival. Our findings need to be proven in further prospective clinical trials.

Zusammenfassung

Hintergrund

Das richtige Erkennen des Schweregrades einer Verletzung ist entscheidend für die Triage und die Behandlung von Schwerstverletzten. Das frühe Abschätzen des Mortalitätsrisikos bei lebensgefährlich verletzten Patienten ist eine Grundvoraussetzung für eine adäquate und zielführende Behandlung. Aktuelle Risikoeinschätzung basiert auf klinischen Diagnosen und Scoringsystemen. In unsere Studie haben wir die Hypothese untersucht, dass ein einfacher Labortest, CK/CK-MB Ratio, möglicherweise die Risikoeinschätzung für die Behandlung von Schwerstverletzten verbessern könnte.

Methodik

In einem Zeitraum von 9 Jahren (2002–2011) konnten 328 nicht selektierte Polytraumapatienten an einem Level I Krankenhaus in unsere Studie inkludiert werden. Die Daten wurden aus dem elektronischen Patienteninformationssystem erhoben, welches im September 1992 erstellt wurde.

Ergebnisse

In unserer Studienpopulation konnten wir eine negative Korrelation zwischen ISS (Injury Severity Score) und Leukozyten. Eine positive Korrelation konnte für Leberenzyme und CK-MB erhoben werden. Die Korrelation zwischen ISS und Na+  war signifikant. Zwischen ISS, K+ und Hb/HK konnte keine Korrelation beobachtet werden. Exitus war assoziiert mit ISS, erhöhten Thrombozyten, CK, CK-MB, CRP, Crea and Na+.

Schlussfolgerung

Mit unserer Studie konnten wir eine signifikante Korrelation zwischen CK-MB Werten und dem Gesamtüberleben in Polytrauma-Patienten zeigen. Daher wäre es möglich, dass in Zukunft CK-MB Werte als Vorhersageparameter für das Überleben dienen könnten. Unsere Ergebnisse müssen durch weiter prospektive Studien bestätigt werden.

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Conflict of interest

We hereby certify that there are no actual or potential conflicts of interest for the authors of the present paper. There are no undisclosed financial or personal relationships with other people or organizations that could inappropriately influence our work. There are no potential conflicts of interest that include employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding.

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Authors and Affiliations

  1. Department of Trauma Surgery, Medical University of Vienna, Vienna, Austria

    Florian M. Kovar MD, Silke Aldrian MD, Vilmos Vécsei, Stefan Hajdu & Thomas Heinz

  2. Institute of Central Laboratory, Wilheminenspital, Vienna, Austria

    Georg Endler

  3. Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Waehringer Guertel 18–20, 1090, Vienna, Austria

    Florian M. Kovar MD & Oswald F. Wagner MD

Authors
  1. Florian M. Kovar MD
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  2. Silke Aldrian MD
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  3. Georg Endler
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  4. Vilmos Vécsei
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  5. Stefan Hajdu
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  6. Thomas Heinz
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  7. Oswald F. Wagner MD
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Correspondence to Oswald F. Wagner MD.

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Kovar, F., Aldrian, S., Endler, G. et al. CK/CK-MB ratio as an indirect predictor for survival in polytraumatized patients. Wien Klin Wochenschr 124, 245–250 (2012). https://doi.org/10.1007/s00508-012-0155-8

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  • DOI: https://doi.org/10.1007/s00508-012-0155-8

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