Investigating Correlation of Lower Extremity Muscle Compartment Syndrome with Muscle Related Serum Enzyme Tests: Is any reliable Biomarker?
Seyed Mansour Alamshah1, Abdolhadi Jahanshahi2, Hossein Minaee1, Abdolrahim Nahid1, Nozar Dorestan1, Alireza Kabiriand Seyed Ali Mohammad Sadat3

1In general and vascular surgery. Golestan hospital, Ahwaz, Iran.

2In Thoracic surgery, Imam Khomeini hospital, Ahwaz, Iran.

3Fellowship in vascular surgery. Sina hospital, Tehran, Iran.

Corresponding Author E-mail:

Abstract: Specific muscle related biomarker might better diagnose the compartment syndrome towards lessen complications. The trial assessed the issue of it’s determining. 149 referral cases of lower extremity injuries were recruited for two sectional assessment of their muscle compartment pressures and simultaneously measurement of serum CPK, LDH, AST (SGOT), Troponin and urine Myoglubin levels. Successive compartment pressure with ΔP recording with timed blood samples were considered on first visit, pre and postoperative and pre-discharge periods. Data were analyzed in fasciotomized patients had acute compartment syndrome for any meaningful biomarker. 122 patients (81%) had lower extremity trauma and 27 cases (19%) had thrombo-embolic vascular events. Outcomes revealed 14 cases that required fasciotomy with the pressure ranges of 35-53 mmHg (mean=46, SD=5.8) and ΔP 24.71 (min=18, max=31, SD= 4.02) before fasciotomy and finally 4 amputations. All above muscle related enzyme tests had maximum thresholds before fasciotomies. Troponin was positive in 3 (21.4%) cases and Urine Myoglubin was positive in 13 patients (92.9%) of 14 fasciotomy. There was no correlation between serum enzyme tests and acute compartment pressures and also with outcome and the type of injuries before fasciotomy as a definite biomarker. Fasciotomy requirement was correlated significantly with tests in all other defined periods (P≤0.007).  We could not statistically find any biomarker to be specified. Significant optimum of serum CPK, LDH and AST before fasciotomy alongside highly positive Myoglubin in them conclude that their measurements are crucial in promoting diagnosis and consequently we claim that sum of thresholds could be more reliable than existence of a biomarker alone.

Keywords: Compartment syndrome biomarker; CPK. LDH; Troponin; Urine Myoglubin

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