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Background <p> Although creatine kinase–MB (CK–MB) is a well-established predictor of myocardial infarction, emerging evidence suggests it has prognostic value in various infections; however, its role in sepsis remains unexplored. This study aims to investigate the predictive value of CK–MB for short-term mortality in elderly patients with sepsis.</p> Methods <p>A total of 1752 patients aged ≥ 60 with sepsis were included and divided into four groups according to the quartiles of CK–MB within 24&#xa0;h after ICU admission: &lt; 6.6 (<i>n</i> = 435), 6.6–10.9 (<i>n</i> = 440), 10.9–18.5 (<i>n</i> = 435) and ≥ 18.5 (<i>n</i> = 442). Multivariate analysis was conducted to investigate the association of CK–MB with 28-day mortality and identify the risk factors for CK–MB elevation.</p> Results <p>Both in-hospital (39.1% vs 43.0% vs 51.3% vs 60.4%, <i>P</i> &lt; 0.001)&#xa0;and 28-day mortality (24.7% vs 30.2% vs 40.8% vs 56.3%, <i>P</i> &lt; 0.001)&#xa0;rose progressively with increasing CK–MB levels. Multivariate Cox regression analysis confirmed log<sub>10</sub> CK–MB (HR=2.32, <i>P</i> &lt; 0.001)&#xa0;and elevated&#xa0;CK–MB (&gt;25U/L;&#xa0;HR=1.92, P&lt;0.001)&#xa0;as independent predictors of 28-day mortality. The Receiver Operation&#xa0;Characteristic&#xa0;curve analysis demonstrated comparable predictive performance between CK-MB and lactic acid for 28-day mortality (Area under the curve: 0.650 vs. 0.649, <i>P</i> = 0.962).&#xa0;Adding CK–MB to APACHE II improved mortality prediction of sepsis&#xa0;(Categorical Net Reclassification Index = 2.5%, <i>P</i> = 0.038). Patients with both CK–MB &gt; 25 U/L and lactate &gt; 2&#xa0;mmol/L had the highest mortality. Liver disease, renal impairment, vasopressor use, and hyperlactatemia were independent risk factors for elevated CK–MB.</p> Conclusions <p>In elderly patients with sepsis, elevated CK–MB level measured upon ICU admission was associated with increased 28-day mortality. The combination of CK–MB and lactic acid levels may enhance risk stratification in sepsis patients.</p>

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Prognostic role of creatine kinase–MB in elderly patients with sepsis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月8日

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  • Jingwen Li,
  • Qi Wang,
  • Shuaizheng Che,
  • Zhonghua Wang,
  • Shenglong Chen,
  • Shouhong Wang,
  • Xuebiao Wei

摘要

Background

Although creatine kinase–MB (CK–MB) is a well-established predictor of myocardial infarction, emerging evidence suggests it has prognostic value in various infections; however, its role in sepsis remains unexplored. This study aims to investigate the predictive value of CK–MB for short-term mortality in elderly patients with sepsis.

Methods

A total of 1752 patients aged ≥ 60 with sepsis were included and divided into four groups according to the quartiles of CK–MB within 24 h after ICU admission: < 6.6 (n = 435), 6.6–10.9 (n = 440), 10.9–18.5 (n = 435) and ≥ 18.5 (n = 442). Multivariate analysis was conducted to investigate the association of CK–MB with 28-day mortality and identify the risk factors for CK–MB elevation.

Results

Both in-hospital (39.1% vs 43.0% vs 51.3% vs 60.4%, P < 0.001) and 28-day mortality (24.7% vs 30.2% vs 40.8% vs 56.3%, P < 0.001) rose progressively with increasing CK–MB levels. Multivariate Cox regression analysis confirmed log10 CK–MB (HR=2.32, P < 0.001) and elevated CK–MB (>25U/L; HR=1.92, P<0.001) as independent predictors of 28-day mortality. The Receiver Operation Characteristic curve analysis demonstrated comparable predictive performance between CK-MB and lactic acid for 28-day mortality (Area under the curve: 0.650 vs. 0.649, P = 0.962). Adding CK–MB to APACHE II improved mortality prediction of sepsis (Categorical Net Reclassification Index = 2.5%, P = 0.038). Patients with both CK–MB > 25 U/L and lactate > 2 mmol/L had the highest mortality. Liver disease, renal impairment, vasopressor use, and hyperlactatemia were independent risk factors for elevated CK–MB.

Conclusions

In elderly patients with sepsis, elevated CK–MB level measured upon ICU admission was associated with increased 28-day mortality. The combination of CK–MB and lactic acid levels may enhance risk stratification in sepsis patients.