Increased serum CK-MB/ CK ratio and its relation to serum uric acid with rotavirus gastroenteritis

  • Kimiko Tatsumi
  • Shoji Tsuji
  • Katsue Funaki
  • Makiko Nakamura
  • Hideki Sawano
  • Yoshiaki Harada
  • Kazunari Kaneko


Background: Rotavirus gastroenteritis (RVG) is higher serum uric acid (s-UA) than other viral gastroenteritis while its pathogenesis remains unclear. Mitochondrial creatine kinase (mtCK), a creatine kinase (CK) isozyme, is reported to be higher in patients with RVG, possibly due to breakdown of intestinal cells. To test the hypothesis that increased serum UA levels with RVG are due to damage to the intestinal cells, which is characterized by concomitant elevation of serum mtCK.Methods: Overall 41 patients had RVG, 29 had norovirus gastroenteritis, 10 had adenovirus gastroenteritis, and 20 had bacterial gastroenteritis. As it is known that mtCK falls within the fraction of creatine kinase-MB (CK-MB) assayed by immunoinhibition method, the CK-MB/CK ratio was compared among the groups to elucidate the levels of mtCK. Furthermore, the relationship between s-UA and the CK-MB/CK ratio was also examined.Results: The RVG group had the highest s-UA level (median 6.7 mg/dL); and levels were significantly higher than healthy subjects (HS), pneumonia, and pharyngitis patients (P = 0.000). The RVG group had a significantly higher CK-MB/CK ratio than other gastroenteritis groups, HS, and disease control groups (P = 0.000). There was a positive correlation between s-UA and CK-MB/CK ratio in patients with gastroenteritis (R = 0.45, P = 0.000).Conclusion: Increased serum CK-MB/CK ratio in patients with RVG indicates the increased mtCK due to tissue breakdown, particularly that of small intestines. Considering the strong relationship between s-UA and CK-MB/CK ratio, it is speculated that the increase in s-UA levels is due to intestinal mucosal injury.


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