Analysis on serum different enzymes in 263 children with critical illness within 2 weeks after admission

【Objective】To analyze the change trends of serum enzymes including ALT, AST, LDH, CK, CKMB, and possible interrelationship between them in children with critical illness, in order to provide help for assessing severity of disease and prognosis.【Methods】The values of ALT, AST, LDH, CK, CKMB were analyzed in 263 cases with critical illness in PICU within 14 days after admission.SPSS 16.0 was used to analyze the related data, in which t-tests and pearson correlation analysis, or Kruskal Wallis and Mann-Whitney U test were applied.【Results】 The mean value of enzymes were significantly higher than definite normal range from admission to 9th day, but having larger standard deviation in all of them.The largest mean of CK, CKMB occurred at 1st day, ALT, AST, LDH at 2nd day, all of which decreased significantly at 9th day.Overall, most of them were increased less than 5 times within 9 days, but some could be up to 50 times.The percent of children with abnormal LDH value was maximum(74.7%), followed by AST and CKMB, CK, ALT.The change trend of the enzymes differed, abnormal value of LDH early appeared and slowly recovered, early abnormal percent of CK was relatively less than CKMB and recovered faster than CKMB, and early abnormal percent of ALT and AST was low and recovered rapidly.The percent of children with the abnormal enzymes and the degree of normality arrived at the peak during 2-3ds, getting better in 3 days.Nevertheless, CK(90%) basically went back to the normal range at the 9th day, other enzymes in more than 50% children were still in abnormal range, especially AST and LDH.According to the analysis of mortality with different values of enzymes in the first 3 day, the mortality with the value of normal range was 15-28%, 2 times than normal range 23%～40%, 5 times 35%～54%, 10 times 40%～60%,-50 times 40%～70%, 50 times 60% more.Although the mortality decreased in children with increased ALT and AST morn than 50 times, the general trend was that the higher the increasing multiple, the worse the prognosis, and the higher the mortality rate(P 0.001), especially when LDH increased in the pattern of stepladder.The patients with significantly increased ALT, AST(50 times) and LDH(10 times) had prolonged hospitalization, and those with significantly increased LDH stayed longer in PICU, but the correlation analysis had no significantly statistical significance between the value of enzymes and stay period of the above.ConclusionThe abnormal rate of serum ALT, AST, LDH, CK, CKMB were different in children with critical illness within 2 weeks after admission, and inter-individual differences in children were larger, of which about half of ALT and CK in the normal range, should be paid attention to the definition of their normal definition which whether or not is over-high.LDH and AST, CKMB better response to tissue damage, in particular, the increased level of LDH can be used as indicators to assess disease prognosis.CKMB increase degree not only prompt myocardial damage, but also may partially reflect brain damage.In course of disease near to 10th day, in addition to CK, the other enzymes in half of the children are still elevated with varying degrees, suggesting that tissue healing is a longer process.