Admission creatine phosphokinase in acute poisoning: is it a predictive factor for the treatment outcome?

Poisoning has reported to be a major cause of death and burden of disease in low- and middle-Income countries. Rhabdomyolysis is a common consequence of many poisoning cases and serum creatine phosphokinase (CPK) is a marker for it. The aim of the study was to assess whether the admission creatine phosphokinase in comatose patients with acute poisoning is a predictive factor for the treatment outcome.

In this prospective observational study, eighty poisoned comatose patients who were admitted with a serum CPK > 250 IU/L (not due to muscular trauma in accidents, myocardial ischemia and infarction, infections, hyperthermia, electrolytic disorders and diabetic ketoacidosis) were included. The severity of poisoning was assessed using Poisoning Severity Score. The admission CPK level; and outcome (survived with and without complication and death) for all patients were recorded. Patients were divided based on CPK levels into three categorizes: Low, medium and high.

Seventy five percent of the patients in high CPK level group, 29.5% in medium CPK level group and 35% in low CPK level group developed complications or death. Binary logistic regression results indicated that the chance of complications is much higher for patients with high admission CPK levels (more than 10000 IU/L) [OR, 5.57; 95% CI (1.29-23.93)] than whom with low levels.

We concluded that the admission serum CPK level for a poisoned patient, seems to be an acceptable predictor for the outcome in poisoned patients. Further studies are still needed.