Serum creatine kinase dynamics in amyotrophic lateral sclerosis: Predictive role of male sex, limb onset, and intermediate disease duration for stratified monitoring

Abstract

Objective

To investigate serum creatine kinase (CK) levels in amyotrophic lateral sclerosis (ALS) patients and their associations with disease characteristics, exploring its utility as a biomarker for disease progression.

Methods

This retrospective study included 81 definitive ALS patients and 99 matched controls. Serum CK levels were analyzed against sex, age, onset site, disease duration, and ALSFRS-R scores using Mann-Whitney U tests, Kruskal-Wallis tests, and multivariate regression.

Results

ALS patients exhibited significantly elevated CK levels compared to controls (233.92 ± 216.91 vs. 101.81 ± 34.28 IU/L, P < 0.05), with 65.43 % exceeding gender-specific ranges. Multivariate analysis identified male sex (β = 0.32, 95 % CI: 0.21–0.43; P < 0.05), limb onset (vs. bulbar: β = 0.41, 95 % CI: 0.29–0.53; P < 0.05), and intermediate disease duration (1–3 years: β = 0.32, P < 0.05) as independent predictors. CK levels peaked in limb-onset patients (lower limb: 342.40 ± 283.53 IU/L vs. bulbar: 96.20 ± 49.39 IU/L; P < 0.05). Higher CK was associated with moderate disease severity (ALSFRS-R 36–40 vs. ≤ 35: P < 0.05).

Conclusion

Serum CK elevation in ALS is strongly linked to male sex, limb onset, and intermediate disease duration (1–3 years), though long-duration cases (>3 years) were underrepresented (n = 4). These findings highlight CK’s potential as a cost-effective biomarker for personalized monitoring, particularly in limb-onset males with moderate functional impairment. Further validation in larger cohorts is warranted.