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Cerebrospinal Fluid Creatine Kinase–BB Isoenzyme Activity and Outcome After Subarachnoid Hemorrhage
William M. Coplin, MD;
W. T. Longstreth, Jr, MD, MPH;
Arthur M. Lam, MD;
Wayne L. Chandler, MD;
Teresa S. Mayberg, MD;
James S. Fine, MD;
H. Richard Winn, MD
Arch Neurol. 1999;56:1348-1352.
Background The brain is rich in creatine kinase–BB isoenzyme activity (CK-BB), which is not normally present in cerebrospinal fluid (CSF). Results of previous studies have shown that CK-BB can be detected in the CSF of patients with aneurysmal subarachnoid hemorrhage (SAH), but whether CK-BB levels correlate with patients' neurologic outcomes is unknown.
Objective To evaluate the relationship between CSF CK-BB level and outcome after SAH.
Design Prospective observational cohort.
Setting University-affiliated tertiary care center.
Patients Convenience sample of 30 patients seen for cerebral aneurysm clipping.
Interventions We sampled and assayed CSF for CK isoenzymes a median of 3 days after SAH in 27 patients, and at the time of unruptured aneurysm clipping in 3 patients.
Main Outcome Measures Without knowledge of CK results, we assigned the Glasgow Outcome Scale score early ( 1 week) and late (2 months) after surgery.
Results Higher CSF CK-BB levels were associated with higher Hunt and Hess grades at hospital admission (Spearman rank correlation,  =0.69; P<.001), lower Glasgow Coma Scale scores at hospital admission (=-0.72; P<.001), and worse early outcomes on the Glasgow Outcome Scale (=-0.64; P<.001). For patients with a favorable early outcome (Glasgow Outcome Scale score, 3-5), all CK-BB levels were less than 40 U/L. With a cutoff value of 40 U/L, CK-BB had a sensitivity of 70% and a specificity of 100% for predicting unfavorable early outcome (Glasgow Outcome Scale score, 1-2). Having a CK-BB level greater than 40 U/L increased the chance of an unfavorable early outcome, from 33% (previous probability) to 100%, whereas a CK-BB level of 40 U/L or less decreased it to 13%. Similar findings were obtained when considering late outcomes.
Conclusion The level of CSF CK-BB may help predict neurologic outcome after SAH.
From the Departments of Neurology (Drs Coplin and Longstreth), Neurological Surgery (Drs Coplin, Lam, and Winn), Laboratory Medicine (Drs Chandler and Fine), and Anesthesiology (Drs Lam and Mayberg), and the Division of Pulmonary and Critical Care Medicine (Dr Coplin), School of Medicine, University of Washington, Seattle.
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