Creatine Kinase Is Associated With Recurrent Stroke and Functional Outcomes of Ischemic Stroke or Transient Ischemic Attack.

On the basis of strong research evidence, Duchenne muscular dystrophy (DMD), the most common severe childhood form of muscular dystrophy, is an X-linked recessive disorder caused by out-of-frame mutations of the dystrophin gene. Thus, it is classified asa dystrophinopathy. The disease onset is before age 5 years. Patients with DMD present with progressive symmetrical limb-girdle muscle weakness and become wheelchair dependent after age 12 years. (2)(3). On the basis of some research evidence,cardiomyopathy and congestive heart failure are usually seen in the late teens in patients with DMD. Progressive scoliosis and respiratory in sufficiency often develop once wheelchair dependency occurs. Respiratory failure and cardiomyopathy are common causes of death, and few survive beyond the third decade of life. (2)(3)(4)(5)(6)(7). On the basis of some research evidence, prednisone at 0.75 mg/kg daily (maximum dose, 40 mg/d) or deflazacort at 0.9 mg/kg daily (maximum dose, 39 mg/d), a derivative of prednisolone (not available in the United States), as a single morning dose is recommended for DMD patients older than 5 years, which may prolong independent walking from a few months to 2 years. (2)(3)(16)(17). Based on some research evidence, treatment with angiotensin-converting enzyme inhibitors, b-blockers, and diuretics has been reported to be beneficial in DMD patients with cardiac abnormalities. (2)(3)(5)(18). Based on expert opinion, children with muscle weakness and increased serum creatine kinase levels may be associated with either genetic or acquired muscle disorders (Tables 1 and 3). (14)(15)

Objective: We aimed to investigate the effect of serum Creatine Kinase (CK) levels on disease progression and prognosis in coronavirus disease 2019 (COVID-19). Methods: This was a retrospective study of 1751 COVID-19 patients at Leishenshan hospital in Wuhan, China. All patients were grouped to normal and elevated CK groups. Univariate and multivariate Cox regression analyses were performed to explore the relationship between mortality and CK levels. Univariate and multivariate logistic regression analyses were performed to explore the relationship between disease severity and CK levels. Survival curves were generated for normal and elevated CK groups. Fitting curves were performed to investigate the relationships between the number of days in hospital and Computed Tomography (CT) score. Results: Elevated CK patients had higher incidences of critical disease severity (P<0.001), death, and higher CT score. There was an association between elevated CK levels and mortality on multivariate Cox regression analysis (HR=7.31; 95% CI, 1.09-48.96; P=0.04). Elevated CK patients were more likely to have critical disease severity on multivariate logistic regression analysis (OR=4.38; 95% CI, 1.16-16.49; P=0.029). Kaplan-Meier curves demonstrated poor prognosis with elevated CK levels (P<0.001). Conclusion: Elevated CK level was an independent risk factor of mortality in COVID-19 patients. Inpatients with elevated CK had a higher risk for mortality, as well as critical severity condition compared with normal CK inpatients. This may help clinicians make more targeted drug choices to treat COVID-19 patients.

BackgroundIt is not well defined whether Guillain–Barré syndrome (GBS) patients with elevated serum creatine kinase (CK) levels have characteristic clinical features and are related to the subgroups of GBS.MethodsWe retrospectively studied 51 consecutive patients with GBS, who visited our hospital, and compared clinical, laboratory and electrophysiological findings between patients with and without elevated CK levels.ResultsOf 51 patients, 14 patients (27%) showed an elevation of serum CK levels. When compared with patients with the normal CK levels, the ratios of male, antecedent infections, and anti-GM1 antibody positivity were significantly higher in patients with elevated CK levels. The ratios of hypoesthesia, cranial nerve involvement, and urinary retention were significantly less in patients with elevated CK levels. There were no significant differences in disability at peak between two groups. In the electrophysiological examination, sensory nerve abnormalities were not observed. Although some patients with elevated CK levels showed prolongation of distal motor latencies (DMLs) and increase of durations in the initial examination, development of the prolongation of DMLs and increase of durations was not observed in the follow-up examinations. The findings were consistent with acute motor axonal neuropathy (AMAN) with reversible conduction failure (RCF) but not acute inflammatory demyelinating polyneuropathy (AIDP).ConclusionsThe results suggest that the GBS patients with elevated CK levels represent not a group of AIDP but a group of AMAN with axonal degeneration or RCF even though the initial electrophysiological examination shows AIDP pattern.

BackgroundThere has been no prior inception cohort data regarding incidence of cardiopulmonary complications and survival in early SSc patients comparing between those with elevated creatine kinase (baseline CK ≥ 500...

Neuroleptic malignant syndrome is an uncommon but dangerous complication of antipsychotic drugs, characterized by clinical symptoms that include hyperthermia, severe muscle rigidity, autonomic dysfunction, and altered mental state. Serum creatine kinase (CK) elevation occurs in over 90% of cases. Many diagnostic criteria sets for neuroleptic malignant syndrome have been proposed, all of which include hyperthermia and muscle rigidity as major symptoms, and serum CK elevation as either a major or minor symptom. In general, elevated CK occurs in the initial stage of neuroleptic malignant syndrome and corresponds temporally with the onset of muscle rigidity. However, in some exceptional cases, CK elevation and emergence of muscle rigidity do not appear in the same stage, making early diagnosis of neuroleptic malignant syndrome more difficult. Two rare cases of neuroleptic malignant syndrome are presented in which elevated serum CK and emergence of muscle rigidity did not occur in the same stage of neuroleptic malignant syndrome. An elevated CK level is common in the early stage of neuroleptic malignant syndrome, suggesting that serum CK elevation is a useful indicator for early detection of neuroleptic malignant syndrome. However, a definitive diagnosis of neuroleptic malignant syndrome must be determined from the presence of specific clinical symptoms.

Serum creatine kinase (CK) elevation can occur in some patients with Graves' disease treated with antithyroid drugs (ATDs). This study retrospectively investigated clinical characteristics and biochemical data of patients with Graves' disease who experienced serum CK elevation during ATD treatment. CK elevation was observed in 29.6% (37/125) of patients, with 11.2% (14/125) being symptomatic. This incidence is higher than previously reported (13.5%). There were no differences in pre-treatment characteristics between patients with and without CK elevation. The intervals between the initiation of ATD treatment or normalization of thyroid function and the onset of CK elevation were 11.3±8.0 and 5.8±6.6 weeks, respectively, and peak serum CK levels averaged 441.9±394.0 IU/l. Markedly elevated serum CK were accompanied by increased serum myoglobin levels. Serum CK elevation occurred either continuously or intermittently, or as a single episode during the course of treatment. Thyroid function at the time of CK elevation varied from hyperthyroid to normal to hypothyroid. In conclusion, serum CK elevation in patients with Graves' disease treated with ATDs is not uncommon, with symptomatic cases accounting for approximately 10%, and the frequency increasing to around 30% when asymptomatic cases are included. The characteristics observed in our patients suggest the involvement of alternative, as yet unknown mechanisms beyond the relative hypothyroidism theory and the ATD side-effect theory in the development of CK elevation during ATD treatment in patients with Graves' disease.

The monocyte to high-density lipoprotein cholesterol ratio (MHR) has emerged as a novel inflammatory biomarker of atherosclerotic cardiovascular disease. However, it has not yet been identified whether MHR can predict the long-term prognosis of ischemic stroke. We aimed to investigate the associations of MHR levels with clinical outcomes in patients with ischemic stroke or transient ischemic attack (TIA) at 3months and 1year. We derived data from the Third China National Stroke Registry (CNSR-III). Enrolled patients were divided into four groups by quartiles of MHR. Multivariable Cox regression for all-cause death and stroke recurrence and logistic regression for the poor functional outcome (modified Rankin Scale score 3-6) were used. Among 13,865 enrolled patients, the median MHR was 0.39 (interquartile range, 0.27-0.53). After adjustment for conventional confounding factors, the MHR level in quartile 4 was associated with an increased risk of all-cause death (hazard ratio [HR], 1.45; 95% confidence interval [CI], 1.10-1.90), and poor functional outcome (odd ratio [OR], 1.47; 95% CI, 1.22-1.76), but not with stroke recurrence (HR, 1.02; 95% CI, 0.85-1.21) at 1year follow-up, compared with MHR level in quartile 1. Similar results were observed for outcomes at 3months. The addition of MHR to a basic model including conventional factors improved predictive ability for all-cause death and poor functional outcome validated by the C-statistic and net reclassification index (all p < 0.05). Elevated MHR can independently predict all-cause death and poor functional outcome in patients with ischemic stroke or TIA.

Studies showed that low-density lipoprotein cholesterol (LDL-C) to triglyceride (TG) ratio could be used as a predictive parameter of low-density lipoprotein oxidation in vivo and the level of small dense LDL-C. However, whether LDL-C/TG ratio is associated with stroke prognosis remains unclear. We investigated the associations of LDL-C/TG ratio with outcomes in patients with acute ischaemic stroke (AIS) or transient ischaemic attacks (TIA) and explored whether it produced more predictive value than LDL-C and TG. Data were derived from the Third China National Stroke Registry (CNSR-III). Multivariable Cox regression for stroke recurrence, composite vascular events and all-cause death and logistic regression for the poor functional outcome (modified Rankin Scale score 3-6) were used. A total of 14123 patients were included. After adjusting for confounding factors, quartile 4 of LDL-C/TG ratio was associated with an increased risk of recurrent stroke (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.03-1.56), composite vascular events (HR,1.23; 95% CI, 1.00-1.52), death (HR,1.70; 95% CI, 1.13-2.54) and poor functional outcome (odds ratio, 1.34; 95% CI, 1.12-1.61) at 3 months follow-up compared with quartile 1. We also found that quartile 4 of LDL-C and TG was positively and negatively associated with poor functional outcome at 3 months, respectively. LDL-C/TG ratio performed better than LDL-C or TG in predicting clinical outcomes. LDL-C/TG ratio was associated with the risk of stroke recurrence, composite vascular events, death and poor functional outcome in patients with AIS or TIA.

Increased Serum Total Creatine Kinase and Creatine Kinase Isoenzyme MB After Cryosurgical Ablation of the Prostate

Neuroleptic malignant syndrome (NMS) is a life-threatening adverse reaction to antipsychotic drugs. Although there is no specific examination able to diagnose NMS, serum creatine kinase (CK) elevation has been reported in over 90% of NMS patients. In this report, we describe a patient who developed NMS but had normal CK levels. The patient presented with hyperthermia of over 38°C, severe muscle rigidity, autonomic dysfunction, and altered mental status. Although serum CK levels were measured three times during the course of NMS, the levels were within the normal range. The patient died of respiratory failure 13 days after the onset of NMS symptoms. As patients without elevated serum CK levels are rarely reported, we discuss potential reasons why the serum CK was not elevated in our patient. This case shows clinicians that although serum CK elevation is a useful indicator for the early detection of NMS, the diagnosis of NMS must be determined by clinical symptoms as otherwise, the appropriate treatment procedures for NMS may be delayed.

The aim was to explore the association of residual inflammatory risk (RIR) with stroke recurrence after an index acute ischaemic stroke or transient ischaemic attack. This study was based on the Third China National Stroke Registry. A total of 5840 patients with two high sensitivity C-reactive protein (hsCRP) measurements at baseline and at 3 months were included in the analysis. High RIR was defined as an hsCRP ≥3mg/l. Patients were divided into four groups: persistent high RIR (first high then high hsCRP), attenuated RIR (first high then low hsCRP), increased RIR (first low then high hsCRP) and persistent low RIR (first low then low hsCRP). The primary outcome was new stroke onset during the 1-year follow-up. Secondary outcomes included composite vascular events, all-cause mortality and poor functional outcome (modified Rankin Scale score 3-6). During the 1-year follow-up, 523 (9.0%) patients had stroke recurrence. Patients with persistent high RIR had an increased risk of stroke recurrence (hazard ratio with 95% confidence interval 1.39, 1.08-1.78), compared with those with persistent low RIR. Similar results were found for the outcome of composite vascular events, mortality and poor functional outcome. An increased risk of stroke recurrence was further found in patients with persistent high RIR and intracranial artery stenosis or large-artery atherosclerosis stroke subtype. In patients with acute ischaemic stroke or transient ischaemic attack, persistent high RIR increased the risks of 1-year stroke recurrence, especially in those with intracranial artery stenosis or large-artery atherosclerosis subtype, composite vascular events, mortality and poor functional outcome.

BackgroundThe prognostic value of serum bilirubin in stroke is controversial, since bilirubin has both neuroprotective and neurotoxic properties. We aimed to investigate the association between serum bilirubin, including total bilirubin (TBIL), direct bilirubin (DBIL) and indirect bilirubin (IBIL) and poor functional outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).MethodsAll patients with AIS or TIA were recruited from the Third China National Stroke Registry. The poor functional outcomes included modified Rankin Scale (mRS) score 2–6 and 3–6 at 3 months and 1 year. Multivariable logistic regression was used to investigate the associations of TBIL, DBIL, and IBIL with poor functional outcomes.ResultsAmong 11,121 enrolled patients, the median (interquartile range) of TBIL, DBIL, and IBIL was 13.30 (9.90–17.70), 3.80 (2.70–5.30), and 9.30 (6.70–12.80) µmol/L. After adjustment for conventional confounding factors, patients in the highest TBIL quartile had the highest proportion of mRS score 2–6 at 3 months (odds ratio [OR], 1.37; 95 % confidence interval [CI], 1.19–1.59) and 1 year (OR, 1.31; 95 % CI, 1.13–1.52), and mRS score 3–6 at 3 months (OR, 1.33; 95 % CI, 1.11–1.59) and 1 year (OR, 1.28; 95 % CI, 1.07–1.53), when compared to patients in the lowest TBIL quartile. Similar results were observed for DBIL and IBIL. We also found J-shaped associations between serum bilirubin levels and each outcome.ConclusionsElevated levels of serum bilirubin were significantly associated with poor functional outcomes in patients with AIS or TIA at 3 months and 1 year.

Elevated serum creatine kinase levels are one of the major criteria for the diagnosis of myocardial injury. Noncardiac causes such as muscular and brain damage may also be associated with...

Background: Oral isotretinoin is a highly effective and widely used therapeutic agent for acne; however, it requires close follow-up due to its potential to produce various side effects. Slightly increased levels of serum creatine kinase (CK) that are either associated or not associated with musculoskeletal symptoms have been commonly reported and are typically considered innocuous. Objectives: The aims of the study are to investigate the frequency of our acne vulgaris patients with elevated serum CK levels during isotretinoin treatment, to analyze their course, and to determine the potential risk factors. Materials and Methods: Data of the patients in an outpatient clinic who were treated with isotretinoin due to acne vulgaris were retrospectively analyzed. Results: A total of 154 patients with at least 3 months of follow-up were included in the study. Elevated serum CK levels were found in 31 patients, and two patients had elevated levels over 1000 IU/l. While male sex was found to be a significant risk factor of CK elevation (P < 0.001), the mean age during the therapy was not found to be significantly different between the two groups. Of the patients with elevated serum CK levels, 16.2% were symptomatic and 29% had a recent history of physical exercise. Conclusions: Although mild elevation of serum CK has a benign course and is not uncommon among acne vulgaris patients who are treated with isotretinoin, remarkable elevations and symptomatic cases are relatively rare. Even CK elevations of more than 1000 IU/l may occur without symptomatic rhabdomyolysis if they are triggered by strenuous physical exercise or other causes during isotretinoin treatment. Further investigation of whether an agreed upon and not currently recommended upper limit for CK level that is tolerable can ensure safer follow-up during isotretinoin treatment is needed.

We compared serum creatine kinase (CK) levels between spinobulbar muscular atrophy (SBMA) and amyotrophic lateral sclerosis (ALS) and reviewed available histochemical studies of frozen sections of muscle biopsies. CK levels and the frequency of patients with elevated CK levels were significantly higher in the SBMA group when compared with the ALS group. CK levels occasionally approached values up to 8 times the upper limit of normal in the SBMA group. In addition to the chronic neurogenic changes in the muscle biopsy, all SBMA patients showed one or more myopathic changes. Increased numbers of markedly hypertrophic fibers were consistently seen in all patients. It is not clear whether the elevated CK level is directly related to the increased number of hypertrophic fibers or to other myopathic features. Based on these findings, we recommend genetic testing for SBMA in cases of male patients with motor neuron disease who present with a significantly elevated serum creatine kinase level, even when other characteristic clinical features of SBMA are absent.