Investigation of predictors of increased creatine kinase levels following vascular surgery and the association with peri-operative statin therapy.
Although peri-operative statin administration is likely to be cardioprotective, there remains a concern about the risk of rhabdomyolysis and associated renal failure following statin administration in the peri-operative period. The aim of this study was to determine independent predictors of creatine kinase (CK) elevation following vascular surgery.


METHODS
A retrospective cohort study was conducted. A multivariate analysis using binary logistic regression was conducted of clinical, surgical and laboratory factors which may be associated with a CK exceeding five times the upper limit of normal (ULN).


RESULTS
Four independent predictors associated with a CK > 5 ULN were identified. Statin therapy was protective [odds ratio (OR) 0.096, 95% confidence interval (CI) 0.014-0.68, p = 0.019], and a serum creatinine > 180 micromol*l(-1), positive serum troponins and embolectomy and/or fasciotomy were associated with CK elevation (OR 3.32, 95% CI: 1.03-10.7, p = 0.04; OR 5.84, 95% CI: 1.52-22.4, p = 0.01; OR 5.62, 95% CI: 1.14-27.8, p = 0.03 respectively). Statin therapy was associated with decreased mortality (OR 0.26, 95% CI: 0.08-0.86, p = 0.028).


CONCLUSIONS
It may be preferable to continue statin therapy in vascular surgical patients even when CK is elevated, as this may decrease mortality if the CK elevation is in the presence of pre-existing renal dysfunction, peri-operative cardiac events or following embolectomy or fasciotomy. Further investigation is required to confirm this observation.
Biccard
B M
BM
Nelson R Mandela School of Medicine, Durban, South Africa. bruce.biccard@nda.ox.ac.uk
D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood*; D004334:Drug Administration Schedule; D017128:Embolectomy / Q000009:adverse effects; D000071938:Fasciotomy; D006331:Heart Diseases / Q000097:blood / Q000150:complications; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D007674:Kidney Diseases / Q000097:blood / Q000150:complications; D016015:Logistic Models; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000139:chemically induced; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014336:Troponin / Q000097:blood; D015854:Up-Regulation; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014336:Troponin; D003402:Creatine Kinase