HyperCKemia and the neutrophil-to-lymphocyte ratio in patients with Guillain–Barré syndrome: a retrospective study

Year 2026, Volume: 7 Issue: 2, 212 - 219, 27.03.2026

Tuba Akıncı , Fatma Zehra Saçma Gökçe , Havva Tuğba Çelik , Cemile Handan Mısırlı

https://izlik.org/JA99UC55FG

Abstract

Aims: Guillain–Barré syndrome (GBS) is an autoimmune disorder with a heterogeneous clinical course, and reliable prognostic biomarkers remain limited. This study evaluated the associations of serum creatine kinase (CK) with clinical severity, electrophysiological subtypes, and short-term (in-hospital) outcomes in GBS, and examined the relationship between the neutrophil-to-lymphocyte ratio (NLR) and clinical and laboratory parameters.
Methods: We retrospectively reviewed patients hospitalized with GBS between January 2019 and October 2025. Fifty-nine eligible patients were included. Electrophysiological subtypes (AIDP/AMAN/AMSAN/normal) were obtained from hospital records. Serum CK was measured once at admission; hyperCKemia was defined as CK ≥200 IU/L. NLR was calculated from admission complete blood counts. Disease severity was assessed using the Hughes Functional Grading Scale at admission and discharge. Requirement for intensive care unit (ICU) admission and length of hospital stay were recorded.
Results: The mean age was 48.27±16.46 years, and 59.32% of patients were male. HyperCKemia was observed in 50.85% (30/59). Electrophysiological subtypes were 42.37% AIDP, 20.34% AMAN, 27.12% AMSAN, and 10.17% normal. ICU admission was required in 18.64% (11/59). HyperCKemia was not associated with length of hospital stay, ICU requirement, or Hughes scores at admission or discharge (all p>0.05), but was associated with higher aspartate aminotransferase levels (p=0.004) and more frequent antecedent infection (p=0.024). NLR showed no association with age, length of stay, CK, C-reactive protein, or Hughes scores (all p>0.05), but was significantly higher in patients requiring ICU care (p=0.006).
Conclusion: HyperCKemia is common in GBS but does not predict short-term outcomes. Elevated NLR in patients requiring ICU admission may help identify severe disease and warrants validation in larger prospective studies.

Keywords

Guillain–Barré syndrome , creatine kinase , hyperCKemia , neutrophil-to-lymphocyte ratio

Ethical Statement

The study was approved by the Ethics Committee of the Ministry of Health and Scientific Research of Haydarpaşa Numune Training and Research Hospital (approval no: HNEAH-GOAEK/KK/2025/169, Date: December 9, 2025).

Supporting Institution

none

References

• Van den Berg B, Walgaard C, Drenthen J, Fokke C, Jacobs BC, van Doorn PA. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol. 2014;10(8):469-482. doi:10.1038/nrneurol. 2014.121
• Sejvar JJ, Baughman AL, Wise M, Morgan OW. Population incidence of Guillain-Barré syndrome: a systematic review and meta-analysis. Neuroepidemiology. 2011;36(2):123-133. doi:10.1159/000324710
• Cabanillas-Lazo M, Quispe-Vicuña C, Cruzalegui-Bazán C, Pascual-Guevara M, Mori-Quispe N, Alva-Diaz C. The neutrophil-to-lymphocyte ratio as a prognostic biomarker in Guillain-Barré syndrome: a systematic review with meta-analysis. Front Neurol. 2023;14:1153690. doi:10.3389/fneur.2023.1153690
• Meyer Sauteur PM, Huizinga R, Tio-Gillen AP, et al. Mycoplasma pneumoniae triggering the Guillain-Barré syndrome: a case-control study. Ann Neurol. 2016;80:566-580. doi:10.1002/ana.24755
• Langmuir AD, Bregman DJ, Kurland LT, Nathanson N, Victor M. An epidemiologic and clinical evaluation of Guillain-Barré syndrome reported in association with the administration of swine influenza vaccines. Am J Epidemiol. 1984;119:841-879. doi:10.1093/oxfordjournals.aje.a113809
• Nasreen S, Jiang Y, Lu H, et al. Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: a multinational self-controlled case series study. Vaccine. 2025;11;60:127291. doi:10.1016/j.vaccine.2025.127291
• Yao J, Zhou R, Liu Y, Lu Z. Progress in Guillain-Barré syndrome immunotherapy-a narrative review of new strategies in recent years. Hum Vaccin Immunother. 2023;19:2215153. doi:10.1080/21645515.2023. 2215153
• Súkeníková L, Mallone A, Schreiner B, et al. Autoreactive T cells target peripheral nerves in Guillain-Barré syndrome. Nature. 2024;626(7997): 160-168. doi: 10.1038/s41586-023-06916-6
• Abbassi N, Ambegaonkar G. Guillain-Barré syndrome: a review. Paediatr Child Health. 2019;29(11):459-62.
• Querol L, Lleixà C. Novel immunological and therapeutic insights in Guillain-Barré syndrome and CIDP. Neurotherapeutics. 2021;18(4):2222-2235. doi:10.1007/s13311-021-01117-3
• Hagen KM, Ousman SS. The neuroimmunology of Guillain-Barré syndrome and the potential role of an aging immune system. Front Aging Neurosci. 2021:12:613628. doi:10.3389/fnagi.2020.613628
• Zahorec R. Neutrophil-to-lymphocyte ratio: past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474-488. doi:10.4149/BLL_ 2021_078
• Bedel C, Korkut M. The clinical significance of neutrophil lymphocyte ratio, monocyte lymphocyte ratio and platelet lymphocyte ratio in patients with Guillain-Barré syndrome. Med J Haydarpaşa Numune Train Res Hosp. 2021;61(3):341-345. doi:10.14744/hnhj.2019.38233
• Geyik S, Bozkurt H, Neyal M, Yigiter R, Kuzudisli S, Kul S. The clinical significance of the neutrophil lymphocyte ratio in patients with Guillain-Barré syndrome independent of infection. Med Sci Discov. 2016;3(8):305-311. doi:10.17546/msd.90383
• Huang Y, Ying Z, Quan W, et al. The clinical significance of neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio in Guillain-Barré syndrome. Int J Neurosci. 2018;128(8):729-735. doi:10.1080/00207454. 2017.1418342
• Satoh J, Okada K, Kishi T, Nagayama S, Kuroda Y. Cramping pain and prolonged elevation of serum creatine kinase levels in a patient with Guillain-Barré syndrome following Campylobacter jejuni enteritis. Eur J Neurol. 2000;7(1):107-109. doi:10.1046/j.1468-1331.2000.00018.x
• Silvestri NJ, Wolfe GI. Asymptomatic/pauci-symptomatic creatine kinase elevations (hyperCKemia). Muscle Nerve. 2013;47(6):805-815. doi:10.1002/mus.23755
• Choi SJ, Hong YH, Kim JS, Shin JY, Sung JJ. HyperCKemia in Guillain-Barré syndrome. Eur Neurol. 2020;83(4):415-420. doi:10.1159/000508747
• Hosokawa T, Nakajima H, Sawai T, et al. Clinical features of Guillain–Barré syndrome patients with elevated serum creatine kinase levels. BMC Neurol. 2020;20(1):214. doi:10.1186/s12883-020-01796-z
• Lee EK, Kim S, Jo N, Sohn E. Association between hyperCKemia and axonal degeneration in Guillain–Barré syndrome. BMC Neurol. 2023; 23(1):92. doi:10.1186/s12883-023-03104-x
• Sejvar JJ, Kohl KS, Gidudu J, et al. Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine. 2011;29(3):599-612. doi:10.1016/j.vaccine.2010.06.003
• Rajabally YA, Durand MC, Mitchell J, Orlikowski D, Nicolas G. Electrophysiological diagnosis of Guillain–Barré syndrome subtype: could a single study suffice? J Neurol Neurosurg Psychiatry. 2015;86(1): 115-119. doi:10.1136/jnnp-2014-307815
• Hughes RA, Newsom-Davis JM, Perkin GD, Pierce JM. Controlled trial prednisolone in acute polyneuropathy. Lancet. 1978;2(8093):750-753. doi:10.1016/s0140-6736(78)92644-2
• Nagappa M, Rahul W, Sinha S, et al. Guillain Barre syndrome in the elderly: experience from a tertiary-care hospital in India. J Clin Neurosci. 2017;46:45-49. doi:10.1016/j.jocn.2017.08.048
• Ropper AH, Shahani BT. Pain in Guillain- Barre syndrome. Arch Neurol. 1984;41(5):511-514. doi:10.1001/archneur.1984.04050170057018
• Tamura N, Kuwabara S, Misawa S, et al. Time course of axonal regeneration in acute motor axonal neuropathy. Muscle Nerve. 2007; 35(6):793-795. doi:10.1002/mus.20729
• Uncini A, Kuwabara S. Electrodiagnostic criteria for Guillain-Barre syndrome: a critical revision and the need for an update. Clin Neurophysiol. 2012;123(8):1487-1495. doi:10.1016/j.clinph.2012.01.025
• Berciano J. Inflammatory oedema of nerve trunks may be pathogenic in very early Guillain-Barre syndrome. Acta Neurol Belg. 2020;120(5):1061-1065. doi:10.1007/s13760-020-01413-3
• Scott AJ, Duncan R, Henderson L, Jamal GA, Kennedy PG. Acute rhabdomyolysis associated with atypical Guillain-Barre syndrome. PostgradMed J. 1991;67(783):73-74. doi:10.1136/pgmj.67.783.73
• Singh NK, Jaiswal AK, Misra S, Srivastava PK. Prognostic factors in Guillain–Barré syndrome. J Assoc Physicians India. 1994;42(10):777-779.