Value of laboratory tests in monitoring acute regional toxicity after isolated limb perfusion.
BACKGROUND
Severe limb toxicity following isolated limb perfusion (ILP) can lead to compartmental compression syndrome and severe rhabdomyolysis, occasionally necessitating amputation of the affected limb. We determined whether laboratory tests for muscle damage and inflammation could predict impending limb toxicity.


METHODS
All 184 consecutive ILPs performed in our institute from 1988 to 1994 were included in this study. Creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (ASAT) and white blood cell (WBC) counts were determined on post-ILP days 1-4, 6, 8, and 15.


RESULTS
"Late peak" CK patterns, characterised by a peak on or after the 5th post-perfusion day, were strongly associated with severe limb toxicity (p < 0.001). Severe toxicity did develop in 40% of the limbs when CK values exceeded 1000 IU/L on the 2nd to 5th post-ILP day (p < 0.001). There was a correlation between the peak CK and the individual grades of toxicity (r = 0.6, p < 0.001). Serum LDH and ASAT values peaked 2.9 and 3.4 days after the CK peak respectively. Severe limb toxicity was statistically significantly associated with higher WBC counts from the 2nd post-ILP day onwards.


CONCLUSIONS
CK values exceeding 1000 IU/L after the 1st and WBC counts increasing after the 2nd post-ILP day could be predictors of impending limb toxicity. These patients should be observed closely for signs of compartmental compression syndrome and severe rhabdomyolysis.
Vrouenraets
B C
BC
Department of Surgery, The Netherlands Cancer Institute (Antoni van Leeuwenhoek ziekenhuis), Amsterdam, The Netherlands.
Kroon
B B
BB
Klaase
J M
JM
Bonfrer
J M
JM
Nieweg
O E
OE
van Slooten
G W
GW
van Dongen
J A
JA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000506:poisoning*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers; D010478:Chemotherapy, Cancer, Regional Perfusion / Q000009:adverse effects* / Q000379:methods; D003161:Compartment Syndromes / Q000097:blood / Q000517:prevention & control; D003402:Creatine Kinase / Q000097:blood; D016903:Drug Monitoring / Q000379:methods*; D005121:Extremities; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000008:administration & dosage; D007770:L-Lactate Dehydrogenase / Q000097:blood; D007958:Leukocyte Count; D016014:Linear Models; D008297:Male; D008545:Melanoma / Q000188:drug therapy*; D008558:Melphalan / Q000008:administration & dosage; D008875:Middle Aged; D011237:Predictive Value of Tests; D012206:Rhabdomyolysis / Q000097:blood / Q000517:prevention & control; D012509:Sarcoma / Q000188:drug therapy*; D018675:Toxicity Tests; D014409:Tumor Necrosis Factor-alpha / Q000008:administration & dosage
D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D007371:Interferon-gamma; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D003402:Creatine Kinase; D008558:Melphalan