title: Peak creatinine kinase level is a key adjunct in the evaluation of critically ill trauma patients.
abstract: BACKGROUND
  Elevated creatinine kinase (CK) can indicate rhabdomyolysis, a risk factor for acute kidney injury (AKI). We investigated risk factors and clinical significance of peak CK levels.
  
  
  METHODS
  Retrospective analysis, adult trauma patients. Logistic regression was used to identify risk factors for elevated CK and AKI.
  
  
  RESULTS
  3240 trauma patients were analyzed; median time to peak CK was 17 h and 347 patients had peak CK > 5000. On multivariable analysis, younger males with severe injury were more likely to have peak CK > 5000 and peak CK > 5000 was an independent risk factor for AKI (AOR 3.79). Although peak CK levels were significantly lower in older patients (1,637U/L vs 2,604U/L), older patients were more likely to develop AKI at lower CK levels.
  
  
  CONCLUSIONS
  CK levels commonly peak within 1-2 days after admission. Despite lower peak CK levels, older patients are more likely to develop AKI. These data may support more rigorous CK monitoring and lower intervention threshold in older patients.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: saskya.byerly@med.usc.edu.
authors.forename: Saskya
authors.initials: S
authors.lastname: Byerly
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: elizabeth.benjamin@med.usc.edu.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Benjamin
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: subarna.biswas@med.usc.edu.
authors.forename: Subarna
authors.initials: S
authors.lastname: Biswas
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: jayuncho11@gmail.com.
authors.forename: Jayun
authors.initials: J
authors.lastname: Cho
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: ewangwhc@gmail.com.
authors.forename: Eugene
authors.initials: E
authors.lastname: Wang
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: monica.wong@med.usc.edu.
authors.forename: Monica D
authors.initials: MD
authors.lastname: Wong
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: kenji.inaba@med.usc.edu.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA. Electronic address: demetrios.demetriades@med.usc.edu.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D000328:Adult; D003402:Creatine Kinase / Q000097:blood*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000097:blood* / Q000150:complications; D014950:Wounds, Penetrating / Q000097:blood* / Q000150:complications; D055815:Young Adult
chemical_list: D003402:Creatine Kinase
keywords: Acute kidney injury; Creatinine; Creatinine kinase; Rhabdomyolysis; Trauma