Association between hyperCKemia and axonal degeneration in Guillain-Barré syndrome

• Published in: BMC neurology Vol. 23; no. 1; p. 92
• Main Authors: Lee, Eun Kyoung, Kim, Sooyoung, Jo, Nathan, Sohn, Eunhee
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 02-03-2023; BioMed Central; BMC
• Subjects: Adenosine; Amantadine; Antibodies; Axonal degeneration; Axons; Creatine; Creatine kinase; Demyelination; Development and progression; Diagnosis; Guillain-Barre syndrome; Guillain-Barre Syndrome - complications; Guillain–Barré syndrome; Health aspects; Hospitalization; Humans; Inflammation; Measurement; Nerve conduction; Nerve Conduction Studies; Neurodegeneration; Neuropathy; Pathophysiology; Polyneuropathy; Prognosis; Retrospective Studies; Reversible conduction failure; Risk factors; Serum levels; South Korea; United States > US; Reversible conduction failure; Guillain–Barré syndrome; Creatine kinase; Axonal degeneration
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-023-03104-x

Elevated serum creatine kinase (CK) levels have been reported in patients with Guillain-Barré syndrome (GBS), more frequently in patients with acute motor axonal neuropathy (AMAN) than in those with acute inflammatory demyelinating polyneuropathy (AIDP). However, some patients with AMAN show reversible conduction failure (RCF), characterized by rapid recovery without axonal degeneration. The present study tested the hypothesis that hyperCKemia is associated with axonal degeneration in GBS, regardless of the subtype.
We retrospectively enrolled 54 patients with AIDP or AMAN whose serum CK levels were measured within 4 weeks from symptom onset between January 2011 and January 2021. We divided them into hyperCKemia (serum CK ≥ 200 IU/L) and normal CK (serum CK < 200 IU/L) groups. Patients were further classified into axonal degeneration and RCF groups based on more than two nerve conduction studies. The clinical features and frequency of axonal degeneration and RCF were compared between groups.
Clinical characteristics were similar in the hyperCKemia and normal CK groups. Compared with that in the RCF subgroup, the frequency of hyperCKemia was significantly higher in the axonal degeneration group (p = 0.007). Patients with normal serum CK levels showed better clinical prognosis, evaluated by the Hughes score at 6 months from admission (p = 0.037).
HyperCKemia is associated with axonal degeneration in GBS, regardless of the electrophysiological subtype. HyperCKemia within 4 weeks from symptom onset might be a marker of axonal degeneration and poor prognosis in GBS. Serial nerve conduction studies and serum CK measurements will help clinicians understand the pathophysiology of GBS.