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Cerebrospinal fluid creatine kinase BB isoenzyme activity and neurologic prognosis after cardiac arrest
D L Tirschwell1, W T Longstreth, M E Rauch-Matthews
1Department of Neurology, School of Public Health and Community Medicine, University of Washington, Seattle 98104-2499, USA.
Insights
Cerebrospinal fluid creatine kinase BB isoenzyme (CSF CKBB) activity is a strong indicator of brain damage and neurologic outcome following cardiac arrest. Elevated CSF CKBB levels correlate with a poor prognosis, aiding in predicting patient recovery.
Area of Science:
- Neurology
- Biochemistry
Background:
- Cardiac arrest frequently leads to significant brain damage.
- Cerebrospinal fluid creatine kinase BB isoenzyme (CSF CKBB) activity is a biomarker reflecting the extent of brain injury.
Purpose of the Study:
- To evaluate the correlation between CSF CKBB levels and neurological outcomes in patients after cardiac arrest.
- To determine the prognostic value of CSF CKBB in clinical practice.
Main Methods:
- CSF CKBB levels were measured in 351 cardiac arrest patients over 7.5 years using agarose electrophoresis.
- Awakening status (comprehensible speech or following commands) was determined by chart review.
Main Results:
- CSF CKBB levels, typically sampled 48-72 hours post-arrest, strongly predicted awakening (p < 0.001).
- Median CSF CKBB was 4 U/l for awakened patients versus 191 U/l for those who never awakened.
- A CSF CKBB cutoff of 204 U/l showed 100% specificity for predicting no awakening, though sensitivity was 48%.
Conclusions:
- CSF CKBB measurement is a valuable tool for assessing brain damage and predicting neurological prognosis after cardiac arrest.
- The retrospective nature of the study suggests potential for self-fulfilling prophecy in the results.
Objective:
To assess the relationship between CSF creatine kinase BB isoenzyme activity (CSF CKBB) and neurologic outcome after cardiac arrest in clinical practice.
Background:
CSF CKBB reflects the extent of brain damage following cardiac arrest.
Methods:
To help with prognosis, treating physicians ordered CSF CKBB tests on 474 patients over 7.5 years; 351 of these patients had experienced a cardiac arrest. Assays were performed in one laboratory using agarose electrophoresis. By chart review, we determined awakening status for all patients, defined as the patient having comprehensible speech or following commands.
Results:
CSF CKBB was usually sampled 48 to 72 hours after cardiac arrest and was strongly associated with awakening (p < < 0.001). The median was 4 U/l for 61 patients who awakened and 191 U/l for 290 who never awakened. For those who awakened, 75% of CKBB levels were < 24 U/l, and for those who never awakened, 75% were > 86 U/l. The highest value in a patient who awakened was 204 U/l, a cutoff that yielded a specificity of 100% of never awakening but a sensitivity of forty-eight percent. Only nine patients who awakened had CSF CKBB values greater than 50 U/l, and none regained independence in activities of daily living. Only three unconscious patients were still alive at last contact, with follow-up of 63, 107, and 109 months. Using logistic regression, the probability of never awakening given a CSF CKBB result can be estimated as: 1/(1 + L), where L = e raised to (0.1267 - 0.0211 x CSF CKBB [U/l]).
Conclusion:
CSF CKBB measurement helps to estimate degree of brain damage and thus neurologic prognosis after cardiac arrest. However, results of this retrospective study could reflect in part a self-fulfilling prophecy.