Role of Serum Creatine Phosphokinase in Predicting Stroke Severity and Short-Term Outcomes: A Prospective Observational Study in a Tertiary Care Hospital in Srinagar (J&K)

Abstract Background: Stroke is a leading cause of disability and mortality worldwide, with an increasing burden in low- and middle-income countries like India. Serum creatine phosphokinase (CPK), a widely available biomarker, may serve as an early indicator of stroke severity and prognosis. This study evaluates the predictive utility of serum CPK in stroke patients admitted within 24 hours of symptom onset.1,2 Methods: A prospective observational study was conducted over 24 months at a tertiary care center in Srinagar, Kashmir. Adults aged >45 years with first-ever strokes were enrolled. Stroke severity and functional outcomes were assessed using the NIH Stroke Scale (NIHSS) at admission and the Modified Rankin Scale (mRS) at 1 and 4 weeks. Serum CPK levels at admission were measured and correlated with clinical outcomes. Results: Among 183 patients (66.7% male, mean age 72.3 ± 6.8 years), ischemic stroke was predominant (76.1%). Elevated serum CPK levels correlated strongly with stroke severity (NIHSS, r = 0.88, p < 0.001) and functional impairment (mRS at 1 week, F = 881.57, p < 0.001; mRS at 4 weeks, F = 175.94, p < 0.001). ROC analysis showed high diagnostic accuracy for mortality (mRS = 6) at 1 week (AUC = 0.984) and 4 weeks (AUC = 0.970). Optimal CPK cut-off values for mortality were 573 IU/L at 1 week and 530 IU/L at 4 weeks. Conclusion: Serum CPK serves as an accessible and cost-effective biomarker for early risk stratification in stroke patients. Its strong correlation with stroke severity and short-term prognosis suggests that CPK testing could enhance clinical decision-making, especially in resource- limited settings.