Study of Serum Creatine Kinase Muscle-Brain Fraction (CK-MB), Cardiac-Troponin-T and Lactate Dehydrogenase (LDH) Levels Among Asphyxiated and Non-Asphyxiated Term Neonates
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- Category: Vol. 81, March 2013
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Study of Serum Creatine Kinase Muscle-Brain Fraction (CK-MB), Cardiac-Troponin-T and Lactate Dehydrogenase (LDH) Levels Among Asphyxiated and Non-Asphyxiated Term Neonates,BOSHRA T. AHMED
Abstract
Objective: Perinatal asphyxia is a common neonatal problem and contributes significantly to neonatal morbidity and mortality. There is a need to identify neonates with asphyxia who will be at high risk for hypoxic ischemic encephalopathy and multi-organ dysfunction.
Hence, this study was conducted to compare the serum levels of creatine kinase muscle-brain fraction (CK-MB), c-troponin-t (c-TnT) and lactate dehydrogenase (LDH) among asphyxiated and non asphyxiated term neonates and to ascertain whether these enzymes can identify asphyxiated neonates.
Methods: A study was conducted on 30 neonates compris-ing the cases and 30 neonates comprising the controls born at AL GALAA teaching hospital from March 2012 to november 2012. Cases and Controls comprised of asphyxiated and non asphyxiated neonates, respectively. The blood samples for CK-MB, C-troponin-t were drawn at 8±2 hours and LDH at 72±2 hours of age and sent for analysis. A serum CK-MB value >92.6U/L, C-troponin value >0.1ng/m1 at 8 hours and LDH value >580U/L at 72 hours was taken as the cut-off level. The sensitivity, specificity, Positive predictive value (PPV), Negative predictive value (NPV) was calculated for CK-MB, C-troponin-t and LDH.
Results: CK-MB, C-troponin-t and LDH were significantly increased in babies with perinatal asphyxia. The mean CK-MB level among cases and control were (126.50±17.34U/1) and (33.63±18.14u/l) respectively with p<0.001, the mean C-troponin-T in cases and control were (0.22±0.01ng/m1) and (0.087±0.002ng/m1) respectively with p<0.001, while LDH levels in cases and control were (554.83±1.95U/1) and (402.57±1.85U/1) respectively with p<0.001.
The cut-off CK-MB value of >92.6U/L has 30% sensitivity with a specificity of 100%. With positive predictive value of 100% and a negative predictive value of 58.8%. The cut-off C-troponin value of >0.1ng/m1 has 26.7% sensitivity with a specificity of 96.7%. With a positive predictive value of 88.9% and a negative predictive value of of 65.9%. The cut-off LDH value of >580 U/L has 96.3% sensitivity with a specificity of 87.9%. With a positive predictive value of 86.7% and a negative predictive value of 96.7%.
Conclusion: Estimation of CK-MB, C-troponin-t at 8 hours of life and LDH at 72 hours of life can help distinguish an asphyxiated from a non-asphyxiated term neonate in correlation with history and clinical features in the neonate.