The liver and blood cells are responsible for creatine kinase clearance in blood Circulation: A retrospective study among different human diseases

Clin Chim Acta. 2023 Apr 1:544:117335. doi: 10.1016/j.cca.2023.117335. Epub 2023 Apr 8.


Background: Muscle damage leads to increased serum creatine kinase (CK) levels in diseases such as acute myocardial infarction. Still, many individuals have abnormal serum CK activities lacking muscle-related diagnoses. The current study hypothesized that failed or overactivated CK clearance by non-muscle organs/tissues might be responsible for increased or decreased CK activities in blood.

Methods: We analyzing 37,081 independent CK test results in 36 human diseases during the past 5 y.

Results: We found that 33 out of 36 diseases were associated with decreased median CK activities compared to healthy controls. Besides muscle damage-related conditions, the highest mean CK activities were observed in hepatitis and cirrhosis. In contrast, 6 blood cell-related illnesses had the lowest mean CK values. ROC analysis showed that CK activities were the best biomarkers (AUC: 0.80-0.94) for the 6 blood-related diseases, especially myeloproliferative disorders. The principal component analysis revealed that the same category of diseases, such as liver-, blood -, kidney-, cancers, and vascular-related diseases, had clustered CK distributions.

Conclusions: We proposed that the liver and blood cells were mainly responsible for CK clearance in blood circulation based on overall results. The testable mechanisms were presented and discussed.

Keywords: Biomarker; Creatine kinase; Principal component analysis; Receiving Operator Curve (ROC).

MeSH terms

  • Biomarkers
  • Blood Cells* / enzymology
  • Creatine Kinase* / metabolism
  • Creatine Kinase, MB Form
  • Disease*
  • Humans
  • Isoenzymes / metabolism
  • Liver* / enzymology
  • Retrospective Studies


  • Biomarkers
  • Creatine Kinase
  • Creatine Kinase, MB Form
  • Isoenzymes