Ian S. Currie, BSc, MBChB, MD, PhD, Sonia J

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Presentation transcript:

Plasma creatine kinase indicates major amputation or limb preservation in acute lower limb ischemia Ian S. Currie, BSc, MBChB, MD, PhD, Sonia J. Wakelin, BSc, MBChB, PhD, Amanda J. Lee, BSc, PhD, Roderick T. Chalmers, MBChB, MD Journal of Vascular Surgery Volume 45, Issue 4, Pages 733-739 (April 2007) DOI: 10.1016/j.jvs.2006.12.050 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 Scatterplot of creatine kinase (CK) levels on admission and amputation. Admission CK is plotted on a log scale according to the duration of acute symptoms. Linear regression analysis confirmed that, in either the amputation or no-amputation group or in the entire cohort, no significant linear relationship existed between the duration of symptoms and CK levels on admission (P = .623, .582, and .405 for the three models, respectively). Journal of Vascular Surgery 2007 45, 733-739DOI: (10.1016/j.jvs.2006.12.050) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 Receiver operator characteristic curve for plasma creatine kinase on admission as a test predictive of major amputation. The curve demonstrates that there is a very strong relationship between increased plasma creatine kinase (CK) and an increased risk of amputation (P < .001) and that the higher the plasma CK, the higher the amputation risk. Sensitivity is the true-positive rate, and 1 − specificity is the false-positive rate. CI, Confidence interval. Journal of Vascular Surgery 2007 45, 733-739DOI: (10.1016/j.jvs.2006.12.050) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 Creatine kinase (CK) levels as a predictive clinical test in acute limb ischemia. The data are shown as the true-positive rate (positive predictive value) with the associated 95% confidence intervals. The true-positive rate describes the percentage of positive test results, for example, CK above threshold, that are associated with amputation. Admission plasma CK was expressed as a multiple of the upper limit of normal CK for men (200 U/L) or women (150 U/L) and grouped into arbitrary subgroups, either below the upper limit of normal (<1×) or greater than once (>1×), twice (>2×), 5 times (>5×), or 10 times (>10×) the upper limit of normal. The number of patients in each group is shown. It should be noted that, for each subgroup, all applicable patients were included, and so any patient whose CK was greater than 10 times normal would qualify for inclusion in each of the lesser subgroups. The 95% confidence interval for CK >10× normal was 0, because all patients underwent amputation in this group. Journal of Vascular Surgery 2007 45, 733-739DOI: (10.1016/j.jvs.2006.12.050) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions