血清肌酸激酶在急诊科疑似药物滥用相关疾病患者中的应用。
The Utility of Serum Creatinine Kinase in Emergency Department Patients with Possible Substance-use Related Conditions.
机构信息
King Saud University, Department of Emergency Medicine, Riyadh, Saudi Arabia.
出版信息
West J Emerg Med. 2020 Sep 4;21(5):1195-1200. doi: 10.5811/westjem.2020.5.46678.
INTRODUCTION
Our goal was to assess the diagnostic utility and temporal kinetics of serum creatine kinase (CK) measurement as a predictor of acute kidney injury (AKI) in emergency department (ED) patients who present with possible substance-use related conditions.
METHODS
This was a retrospective chart review of ED patients with a urine drug screen (UDS) ordered and resulted between 2009-2013. Data was extracted electronically from EPIC Systems electronic health records, populated into a Microsoft Excel file, and includes demographics, chief complaint, vital signs, neuro-psychiatric physical examination findings, laboratory findings, psychiatric consult order time, ED medications given, orders, disposition and its time, and diagnosis.
RESULTS
Of 74,970 patients with an ED UDS, 22,101 (29%) had at least one CK measured. After inclusion and exclusion criteria, 2858 (13%) remained. Mean (standard deviation [SD]) age was 43.3 (12.5) years, 73% were male, 61% Black, 22% White, and 17% Hispanic. Mean (SD) ED length of stay was 10.4 (5.8) hours, and 56.7% were hospitalized. On average, CK was higher at 6-12 hours (p<0.001) and 12-18 hours (p=0.016) compared to 6 hours. CK was lower at 42-56 hours (p = 0.011), 72 hours (p<0.001), and over 72 hours (p<0.001), compared to 6 hours. Maximum CK was determined in those with >2 CK measures. We defined AKI risk as a creatinine of >1.4 milligrams per deciliter based on RIFLE criteria. AKI risk was calculated among those with at least two creatinine values in 522 patients. We identified five (1%) patients as having AKI risk. The odds of AKI risk were not associated with increase in CK over time.
CONCLUSION
In 74,970 ED patients undergoing UDS testing for potential substance abuse, there was no identifiable CK level associated with AKI risk. In patients with possible substance-use conditions, CK continued to trend up even after six hours from door time and began to decrease after 42 hours. We found no value in repeated ED CK measures. Disposition should not be based solely on CK levels.
简介
我们的目标是评估血清肌酸激酶（CK）测量作为急诊科（ED）出现可能与物质使用相关情况的患者急性肾损伤（AKI）预测指标的诊断效用和时间动力学。
方法
这是一项对 2009 年至 2013 年间进行尿液药物筛查（UDS）的 ED 患者的回顾性图表审查。数据从 EPIC Systems 电子健康记录中以电子方式提取，填入 Microsoft Excel 文件中，包括人口统计学、主要投诉、生命体征、神经精神病理学体检结果、实验室结果、精神科咨询医嘱时间、ED 用药、医嘱、处置及其时间和诊断。
结果
在 74970 名接受 ED UDS 的患者中，有 22101 名（29%）至少测量了一次 CK。经过纳入和排除标准，有 2858 名（13%）患者符合条件。平均（标准差[SD]）年龄为 43.3（12.5）岁，73%为男性，61%为黑人，22%为白人，17%为西班牙裔。平均（SD）ED 住院时间为 10.4（5.8）小时，56.7%住院。平均而言，CK 在 6-12 小时（p<0.001）和 12-18 小时（p=0.016）更高，而在 6 小时时较低。在 42-56 小时（p = 0.011）、72 小时（p<0.001）和超过 72 小时（p<0.001）时，CK 较低，而在 6 小时时较高。在有 >2 次 CK 测量的患者中确定了最大 CK。我们根据 RIFLE 标准将 AKI 风险定义为肌酐 >1.4 毫克/分升。在 522 名至少有两次肌酐值的患者中计算了 AKI 风险。我们发现有 5 名（1%）患者存在 AKI 风险。CK 随时间的增加与 AKI 风险无关。
结论
在 74970 名接受 UDS 测试以检测潜在药物滥用的 ED 患者中，没有发现与 AKI 风险相关的可识别 CK 水平。在可能有物质使用情况的患者中，即使在从门口开始 6 小时后，CK 仍持续上升，在 42 小时后开始下降。我们发现 ED CK 重复测量没有价值。处置不应仅基于 CK 水平。
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