Cerebrospinal fluid creatine kinase-BB isoenzyme activity and outcome after subarachnoid hemorrhage

被引:21
作者
Coplin, WM
Longstreth, WT
Lam, AM
Chandler, WL
Mayberg, TS
Fine, JS
Winn, HR
机构
[1] Wayne State Univ, Dept Neurol, Sch Med, Detroit, MI 48201 USA
[2] Wayne State Univ, Dept Neurol Surg, Sch Med, Detroit, MI 48201 USA
[3] Wayne State Univ, Dept Lab Med, Sch Med, Detroit, MI 48201 USA
[4] Wayne State Univ, Dept Anesthesiol, Sch Med, Detroit, MI 48201 USA
[5] Wayne State Univ, Div Pulm & Crit Care Med, Sch Med, Detroit, MI 48201 USA
关键词
D O I
10.1001/archneur.56.11.1348
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: The brain is rich in creatine kinase-BB isoenzyme activity (CK-BB), which is not normally present in cerebrospinal fluid (CSF). Results of previous studies have shown that CK-BB can be detected in the CSF of patients with aneurysmal subarachnoid hemorrhage (SAH), but whether CK-BB levels correlate with patients; neurologic outcomes is unknown. Objective: To evaluate the relationship between CSF CK-BB level and outcome after SAH. Design: Prospective observational cohort. Setting: University-affiliated tertiary care center. Patients: Convenience sample of 30 patients seen for cerebral aneurysm flipping. Interventions: We sampled and assayed CSF for CK isoenzymes a median of 3 days after SAH in 27 patients, and at;he time of unruptured aneurysm clipping in 3 patients. Main Outcome Measures: Without knowledge of CK results, we assigned the Glasgow Outcome Scale score early (approximate to 1 week) and late (approximate to 2 months) after surgery. Results: Higher CSF CK-BB levels were associated with higher Hunt and Hess grades at hospital admission (Spearman rank correlation, rho = 0.69; P < .001), lower Glasgow Coma Scale scores at hospital admission (rho = -0.72; P < .001), and worse early outcomes on the Glasgow Outcome Scale (rho = -0.64, P < .001). For patients with a favorable early outcome (Glasgow Outcome Scale score, 3-5), all CK-BB levels were less than 40 U/L. With a cutoff value of 40 U/L, CK-BB had a sensitivity of 70% and a specificity of 100% for predicting unfavorable early outcome (Glasgow Outcome Scale score, 1-2). Having a CK-BB level greater than 40 U/L increased the chance of an unfavorable early outcome, from 33% (previous probability) to 100%, whereas a CK-BB level of 40 U/L or less decreased it to 13%. Similar findings were obtained when considering late outcomes. Conclusion: The level of CSF CK-BB may help predict neurologic outcome after SAH.
引用
收藏
页码:1348 / 1352
页数:5
相关论文
共 27 条
[1]   ENZYMATIC CHANGES IN SERUM AND CEREBROSPINAL-FLUID IN NEUROLOGICAL INJURY [J].
BAKAY, RAE ;
WARD, AA .
JOURNAL OF NEUROSURGERY, 1983, 58 (01) :27-37
[2]   CREATINE-KINASE BB ISOENZYME LEVELS BY RADIOIMMMUNOASSAY IN PATIENTS WITH NEUROLOGICAL DISEASE [J].
BELL, RD ;
ROSENBERG, RN ;
TING, R ;
MUKHERJEE, A ;
STONE, MJ ;
WILLERSON, JT .
ANNALS OF NEUROLOGY, 1978, 3 (01) :52-59
[3]   QUANTIFICATION OF CEREBRAL INFARCT SIZE BY CREATINE KINASE-BB ISOENZYME [J].
BELL, RD ;
ALEXANDER, GM ;
NGUYEN, T ;
ALBIN, MS .
STROKE, 1986, 17 (02) :254-260
[4]   MITOCHONDRIAL AND MB ISOENZYMES OF CREATINE-KINASE IN CEREBROSPINAL-FLUID FROM PATIENTS WITH HYPOXIC-ISCHEMIC BRAIN-DAMAGE [J].
CHANDLER, WL ;
CLAYSON, KJ ;
LONGSTRETH, WT ;
FINE, JS .
AMERICAN JOURNAL OF CLINICAL PATHOLOGY, 1986, 86 (04) :533-537
[5]  
CHANDLER WL, 1984, CLIN CHEM, V30, P1804
[6]   CREATINE KINASE IN HUMAN TISSUES [J].
DAWSON, DM ;
FINE, IH .
ARCHIVES OF NEUROLOGY, 1967, 16 (02) :175-+
[7]  
DUBO H, 1967, LANCET, V2, P743
[8]   CEREBROSPINAL-FLUID CREATINE-PHOSPHOKINASE IN ACUTE SUBARACHNOID HEMORRHAGE [J].
GREENBLATT, SH .
JOURNAL OF NEUROSURGERY, 1976, 44 (01) :50-54
[9]  
HERSCHKOWITZ N, 1967, J NEUROL NEUROSUR PS, V27, P247
[10]   SURGICAL RISK AS RELATED TO TIME OF INTERVENTION IN REPAIR OF INTRACRANIAL ANEURYSMS [J].
HUNT, WE ;
HESS, RM .
JOURNAL OF NEUROSURGERY, 1968, 28 (01) :14-&