Creatine-Kinase-BB after severe head-injury as an index of prognosis in relation to nature of trauma and patients age

✓ The present study of 43 patients with severe head injury shows that outcome prediction can be markedly improved by combining an appropriate marker of the degree of initial brain damage and other risk factors. The patients were classified into three groups according to their actual outcome after 6 months: death (22 patients); persistent vegetative state or severe disability (eight patients); and moderate disability or good recovery (13 patients). By applying stepwise logistic discriminant analysis to the patients' data, five significant risk factors were selected: degree of neurological damage assessed by cerebrospinal fluid (CSF) extrapolated creatine kinase BB isoenzyme activity, Glasgow-Liege Coma Scale score, age, incidence of thoracic injury, and intracranial pressure (ICP). Extrapolated creatine kinase BB activity had the highest prognostic ability (67%). Uncontrollable elevated ICP proved to be systematically associated with death, whereas its absence was not necessarily indicative of a favorable outcome. The combination of the five variables yielded a total prognostic efficiency of 91%. The percentages of correctly predicted patients for the three outcome groups were, respectively, 100%, 50%, and 100%. Thus, half of the persistently vegetative and severely disabled patients were identified by the selected factors.

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“Extrapolated” creatine kinase-BB isoenzyme activity in assessment of initial brain damage after severe head injury

Journal of Neurosurgery ◽

10.3171/jns.1987.66.5.0714 ◽

1987 ◽

Vol 66 (5) ◽

pp. 714-717 ◽

Cited By ~ 12

Author(s):

Pol Hans ◽

Jacques Daniel Born ◽

Adelin Albert

Keyword(s):

Creatine Kinase ◽

Head Injury ◽

Brain Damage ◽

Head Trauma ◽

Severe Head Injury ◽

Scoring Systems ◽

True Negative ◽

Content Type ◽

Creatine Kinase Bb ◽

Fine Print

✓ The severity of initial brain damage is an important risk factor in determining the prognosis of head trauma. It can be assessed by assigning neurological scores or by determining the cerebrospinal fluid (CSF) activity of the isoenzyme creatine kinase-BB (CK-BB). In 10 severely head-injured patients serial CSF samples were obtained during the first 24 hours after trauma, and exponential decay of CK-BB activity with an average half-life of 4.5 hours was demonstrated. This finding led the authors to propose an “extrapolated” CK-BB activity, which theoretically occurs immediately after injury and is calculated from a single CK-BB recording, as a new index for assessing the degree of initial brain damage. In 50 patients with severe head injury, the prognostic ability of “observed” and “extrapolated” CK-BB activity was compared with two clinical scoring systems that evaluate severity of head trauma (the Glasgow and the Glasgow-Liège Coma Scales). “Extrapolated” CK-BB activity proved to be the best prognostic factor. With a CK-BB cutoff point of 330 U/liter, a true-positive rate of 79% and a true-negative rate of 73% were obtained. These results suggest the usefulness of measuring CK-BB activity in CSF as soon as possible after hospital admission for head injury.

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Multivariate analysis of plasma enzyme profiles in severe head injury.

Clinical Chemistry ◽

10.1093/clinchem/29.1.107 ◽

1983 ◽

Vol 29 (1) ◽

pp. 107-109 ◽

Cited By ~ 1

Author(s):

A Bourguignat ◽

G Ferard ◽

G Jung ◽

T Klumpp ◽

P Metais

Keyword(s):

Creatine Kinase ◽

Multivariate Analysis ◽

Lactate Dehydrogenase ◽

Head Injury ◽

Severe Head Injury ◽

Stepwise Discriminant Analysis ◽

Prognostic Information ◽

Head Injured ◽

Injured Patients

Abstract We followed the changes in the activities of four enzymes (aldolase, aspartate aminotransferase, creatine kinase, and lactate dehydrogenase) in plasma for four days after head injury. The progression of the changes differs significantly between survivors and nonsurvivors. Stepwise discriminant analysis, involving the four enzymes, allowed us to divide 81 to 92% of head-injured patients (n = 280 selected without conscious bias) correctly into the two groups as early as 72 h after trauma. Most of the patients who were misclassified according to our biochemical criteria had received phenobarbital for sedation. Valuable prognostic information in head injury evaluation may thus be obtained by daily determination of enzymatic activities of these four enzymes.

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Increased serum creatine kinase BB and neuron specific enolase following head injury indicates brain damage

Acta Neurochirurgica ◽

10.1007/bf01406367 ◽

1992 ◽

Vol 115 (3-4) ◽

pp. 106-111 ◽

Cited By ~ 105

Author(s):

I. M. Skogseid ◽

H. K. Nordby ◽

P. Urdal ◽

E. Paus ◽

F. Lilleaas

Keyword(s):

Creatine Kinase ◽

Head Injury ◽

Brain Damage ◽

Neuron Specific Enolase ◽

Serum Creatine Kinase ◽

Creatine Kinase Bb

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The diagnostic value of measuring creatine kinase BB activity in cerebrospinal fluid following acute head injury

Acta Neurochirurgica ◽

10.1007/bf01405445 ◽

1982 ◽

Vol 65 (1-2) ◽

pp. 93-101 ◽

Cited By ~ 26

Author(s):

H. K. Nordby ◽

P. Urdal

Keyword(s):

Cerebrospinal Fluid ◽

Creatine Kinase ◽

Head Injury ◽

Diagnostic Value ◽

Creatine Kinase Bb ◽

Acute Head Injury

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Creatine kinase isoenzymes in severe head injury

Journal of Neurosurgery ◽

10.3171/jns.1983.58.5.0689 ◽

1983 ◽

Vol 58 (5) ◽

pp. 689-692 ◽

Cited By ~ 34

Author(s):

Pol Hans ◽

Jacques Daniel Born ◽

Jean-Pierre Chapelle ◽

Germain Milbouw

Keyword(s):

Cerebrospinal Fluid ◽

Creatine Kinase ◽

Head Injury ◽

Intracranial Pressure ◽

Severe Head Injury ◽

Brain Dysfunction ◽

Quantitative Index ◽

Reliable Criterion ◽

Content Type ◽

Fine Print

✓ Brain-type creatine kinase (CK) isoenzyme (CK-BB) was found in the ventricular cerebrospinal fluid (CSF) and the serum in a series of 35 patients within 13 hours following severe head injury. There was a good correlation between total CK and CK-BB activities in CSF only. The values found in the CSF appear to be a quantitative index of brain dysfunction at admission, and did not correlate with intracranial pressure activity. High levels of CK-BB in the CSF correlated with a poor outcome, and thus offer a reliable criterion for the assessment of the severity of head injury.

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