The elevation of creatine kinase and lactic dehydrogenase levels are markers of a low flow state and poor tissue perfusion after cardiac surgery

• Published in: Cirugía cardiovascular 2024-09, Vol.31 (5), p.193-199
• Main Authors: Manzur-Sandoval, Daniel, Gopar-Nieto, Rodrigo, Salazar-Delgado, José Octavio, Espinosa-Soto, Ramón, Soria-García, Rodrigo, Elizalde-Silva, José Luis, Jiménez-Rodríguez, Gian Manuel, Rojas-Velasco, Gustavo
• Format: Article
• Language: English
• Subjects: Cardiac surgery; Choque; Cirugía cardíaca; CO2 derived indices; Isquemia del músculo esquelético; Postcardiotomy low output syndrome; Shock; Skeletal muscle ischemia; Síndrome de bajo gasto poscardiotomía; Índices derivados de CO2
• ISSN: 1134-0096
• DOI: 10.1016/j.circv.2024.03.011

In skeletal muscle, adenosine triphosphate stores decrease during the first 3h of ischemia. In the present study, we performed a comprehensive hemodynamic evaluation during the postoperative period after cardiac surgery and measured skeletal muscle enzyme levels and markers of muscle damage and inflammation. The aim was to determine whether these values change and, if so, whether these changes coincide with the presence of low flow and poor perfusion. We included a cohort of 280 nonconsecutive adults who were monitored in the postoperative period following cardiac surgery. We measured hemodynamic indices repeatedly in the first 24h postoperatively, and we identified differences between the levels of skeletal muscle enzymes and muscle damage markers on admission (0h) and 12 and 24h postoperatively. A clinically and statistically significant elevation of creatine kinase (CK) level was observed at 12h postoperatively in patients with low macrocirculatory flow and anaerobic metabolism. Lactate dehydrogenase (LDH) level was significantly elevated in these patients at 24h. In the first 24h after cardiac surgery, a state of low macrocirculatory flow and the consequent deficit in flow at the capillary–cell interface in the presence of anaerobic metabolism was associated with clinically and statistically significant elevations of CK level at 12h and LDH level at 24h. These changes may be markers of skeletal muscle ischemia and may provide an additional tool in the monitoring and resuscitation of these critically ill patients. En el músculo esquelético, las reservas de trifosfato de adenosina disminuyen durante las primeras 3h de isquemia. En el presente estudio, realizamos una evaluación hemodinámica integral durante el período postoperatorio de cirugía cardíaca, y medimos los niveles de enzimas del músculo esquelético y los marcadores de daño muscular. El objetivo fue determinar si estos valores cambian y, en caso afirmativo, coinciden con la presencia de bajo flujo y mala perfusión. Incluimos una cohorte de 280 adultos no consecutivos que fueron monitorizados en el postoperatorio de cirugía cardíaca. Medimos los índices hemodinámicos postoperatoriamente, e identificamos diferencias entre los niveles de enzimas del músculo esquelético y los marcadores de daño muscular al ingreso (0h) y a las 12 y 24h, postoperatoriamente. Se observó una elevación clínica y estadísticamente significativa del nivel de creatina cinasa (CK) a las 12h del postoperatorio en los paciente