Predictive value of plasma and peritoneal creatine kinase in horses with strangulating intestinal lesions.
Authors: Kilcoyne Isabelle, Nieto Jorge E, Dechant Julie E
Journal: Veterinary surgery : VS
Summary
# Peritoneal Creatine Kinase as a Diagnostic Marker for Strangulating Colic When a horse presents with colic, distinguishing strangulating lesions from non-strangulating conditions is critical for determining urgency of surgical intervention, yet clinical signs alone can be ambiguous. Kilcoyne and colleagues measured creatine kinase (CK) activity in peritoneal fluid and plasma from 10 healthy control horses, 40 with non-strangulating colic, and 21 with confirmed strangulating lesions to evaluate whether these markers could improve diagnostic accuracy. A peritoneal CK threshold of 16 IU/L demonstrated exceptional sensitivity (95.2%) for identifying strangulation with a negative predictive value of 97%, meaning a normal result makes strangulation highly unlikely—though specificity was moderate at 84.6%, indicating some false positives. Peritoneal lactate, by comparison, offered greater specificity (92%) but lower sensitivity (81%), suggesting these markers provide complementary rather than redundant information. For practitioners and veterinarians, peritoneal CK analysis represents a practical adjunct to physical examination and standard peritoneal fluid parameters that could accelerate the confidence to proceed with surgical exploration in equivocal cases, potentially improving survival outcomes in this time-critical condition.
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Practical Takeaways
- •Use peritoneal CK measurement (≥16 IU/L) as a sensitive screening tool to rapidly identify horses likely to have strangulating colic requiring emergency surgery
- •Combine peritoneal CK with lactate measurement for complementary diagnostic value—CK catches more cases (95% sensitive) while lactate provides stronger specificity (92%) to reduce false positives
- •A normal peritoneal CK level has high reassurance value (97% NPV) for ruling out strangulating lesions, potentially avoiding unnecessary surgery in borderline cases
Key Findings
- •Peritoneal CK cutoff of 16 IU/L achieved 95.2% sensitivity and 84.6% specificity for detecting strangulating lesions
- •Peritoneal lactate cutoff of 3.75 mmol/L achieved 81% sensitivity and 92% specificity for detecting strangulating lesions
- •Peritoneal CK showed 97% negative predictive value, making it excellent for ruling out strangulating lesions
- •Peritoneal CK is more sensitive while peritoneal lactate is more specific for strangulating lesion detection