Diagnostic Performance of Serum Creatine Kinase and Lactate in Acute Compartment Syndrome of the Extremities: A Systematic Review and Meta-analysis

Acute compartment syndrome (ACS) is a time-critical surgical emergency requiring prompt diagnosis to prevent irreversible tissue damage. Current diagnostic methods rely on subjective clinical findings and invasive intracompartmental pressure measurement, both with significant limitations. Serum biomarkers may provide non-invasive adjuncts, particularly in patients with unreliable clinical examinations. This study aims to evaluate the diagnostic association of serum creatine kinase (CK) and lactate levels with ACS in patients with extremity trauma. A systematic literature search was performed in PubMed, Embase, and Scopus as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline (PROSPERO Registration: CRD420261351683) from inception through February 2026. Studies evaluating serum CK or lactate in patients with suspected or confirmed ACS with comparison groups were included. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Threshold-based analyses pooled odds ratios (ORs) with 95% confidence intervals (CIs) using fixed-effect models. Continuous biomarker levels were analyzed using standardized mean differences (SMDs) with random-effects models. Four studies comprising 1158 patients (481 ACS cases, 677 controls) were included. For CK, thresholds above 4000 U/L show the strongest associations (OR > 4.0). Continuous CK analysis showed higher levels in ACS patients but did not reach significance (SMD 5.80, 95% CI − 4.55 to 16.16). For lactate, thresholds exceeding 4 mmol/L demonstrate the greatest utility (OR > 4.0). Continuous lactate analysis showed trends toward higher levels (SMD 0.54, 95% CI − 0.00 to 1.08). Elevated serum CK and lactate levels are significantly associated with ACS, with higher thresholds demonstrating stronger diagnostic associations. These biomarkers show promise as non-invasive adjuncts to clinical assessment but should not be used as standalone diagnostic tests. Prospective validation studies are needed to define optimal thresholds for clinical decision-making.