Prognostic value of serum myoglobin in patients after cardiac surgery.
OBJECTIVE
Serum myoglobin as a marker of myocardial damage and injury has been shown to be of prognostic value in patients with cardiovascular events. In this study, we analyzed the prognostic value of serum myoglobin in comparison to other parameters of muscle damage and renal function in patients after cardiac surgery.


METHODS
We retrospectively analyzed data from 373 cardiac surgical patients (mean age, 66 +/- 10 years; range, 30-88 years) by using the highest levels of serum myoglobin, creatinine, and creatine phosphokinase (CK) within the first 24 h after admission to the Intensive Care Unit (ICU). Patients' severity of illness was assessed by the Acute Physiology and Chronic Health Evaluation (APACHE) II score. Predictive properties, in terms of ICU mortality and need for renal replacement therapy (RRT), were analyzed by receiver operating characteristics (ROC) statistics and described by the area under the curve (AUC).


RESULTS
Serum myoglobin was significantly higher in nonsurvivors (n = 29) than in survivors (n = 344; median, 1449 vs 356 microg x l(-1); P < 0.001). With respect to ICU mortality, AUCs were 0.81 for myoglobin, 0.80 for creatinine, and 0.63 for CK. For comparison, an AUC of 0.82 was found for the APACHE II score. In terms of the need for RRT, AUCs were 0.87 for myoglobin, 0.92 for creatinine, and 0.60 for CK. For both endpoints, the AUCs of myoglobin and creatinine were significantly higher than that for CK.


CONCLUSIONS
Serum myoglobin is associated with outcome in patients after cardiac surgery. Prediction of ICU mortality and need for RRT was comparable for myoglobin and creatinine, while both were significantly superior to CK.
Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University of Jena, Jena, Germany.
Denis
D
Hofmann
Marco
M
Buettner
Florian
F
Rissner
Manuela
M
Wahl
Samir G
SG
Sakka
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood*; D011379:Prognosis; D012372:ROC Curve; D012016:Reference Values; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate
D015415:Biomarkers; D009211:Myoglobin; D003404:Creatinine; D003402:Creatine Kinase