Serum levels of myoglobin, creatine phosphokinase, and smooth muscle heavy-chain myosin in patients with ectopic pregnancy

Study objective: Serum markers of smooth muscle destruction have been shown to be elevated in ectopic pregnancy, they remain of questionable clinical utility. Our goal was to determine the clinical utility of 3 markers of smo oth muscle destruction: creatine phosphokinase (CPK), smooth muscle heavy-c hain myosin (SMHC), and myoglobin. Methods: This was a prospective cohort study, with consecutive enrollment o f all women in the first trimester of pregnancy who presented to our urban emergency department with complaints of lower abdominal pain, vaginal bleed ing, or both. Patients were excluded from the study if there was a history of recent surgery or major trauma, Data analysis included receiver operatin g characteristic (ROC) curve, 95% confidence intervals (Cls), and a regress ion model. Results: A total of 378 patients were enrolled, with 61 patients diagnosed with an ectopic pregnancy, and 317 patients placed in the non-ectopic pregn ancy group with other diagnoses. ROC curve analysis revealed an area under the curve of 0.56 (95% Cl 0.51 to 0.61) for CPK, 0.63 (95% Cl 0.59 to 0.68) for SMHC, and 0.58 (95% Cl 0.53 to 0.63) for myoglobin, A regression model analyzing the effects of race, maternal age, estimated gestational age, an d serum levels of human chorionic gonadotropin beta -subunit found no signi ficant confounders. Conclusion: Although there is a statistically significant elevation in the serum levels of SMHC, the range of values seen too large to allow SMHC to b e a useful screening tool.