Serum enzymes studied:
(1) LDH
(2) CK
(3) AST
(4) ALT
The serum LDH was the most useful indicator of prognosis, followed by CK and AST, with ALT giving the least accuracy. The increases could correlate with rhabdomyolysis or liver damage but not to dehydration.
Patterns shown:
(1) no significant elevation during the 24 hours, giving a line with a zero slope
(2) a mild to moderate rise in serum LDH up to 12 hours, followed by a decline towards normal at 24 hours
(3) initially increased serum levels that continue to increase over the next 24 hours, with value at 24 hours > value at 12 hours.
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Pattern
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Prognosis
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no elevation, flat
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good
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elevated by 12 hours but decline by 24 hours
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survival but after prolonged coma
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continuously increasing
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poor (death)
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I would imagine that there also would be a subset of patients showing little change between 24 and 48 hours, who would have a guarded prognosis.
Performance:
• The authors found that the enzyme pattern was superior to body temperature, anion gap and serum potassium for predicting outcome.
Limitations:
• Pre-existing elevation of LDH due to liver or other disease would affect the time course for the LDH pattern.
