Elevated levels of serum muscle enzymes in the initial phase of tick-borne encephalitis

Figures & data

Table 1. Demographic and clinical data on 24 patients with the initial as well as meningoencephalitis phase of tick-borne encephalitis.

Characteristic	Number (%, 95% CI) or median (IQR, range)
Male sex	8 (33.3, 15.6–55.3)
Age (years)	52 (41–61, 28–84)
Underlying illnesses	10 (41.7, 22.1–63.4)
Immune deficiency	2 (8.3, 1.0–27.0)
Ischemic heart disease	2 (8.3, 1.0–27.0)
Treatment with statins	5 (20.8, 7.1–42.2)
Clinical presentation of initial phase
Fever ≥37.5 °C	22 (91.7, 91.3–99.4)
The highest temperature (°C)	38.5 (37.8–38.7, 37.5–40.0)
Chills	4 (16.7, 4.7–37.4)
Headache	22 (91.7, 91.3–99.4)
Myalgias	14 (58.3, 36.6–77.9)
Arthralgias	8 (33.3, 15.6–55.3)
Abdominal pain	4 (16.7, 4.7–37.4)
Nausea, vomiting	12 (50.0, 29.1–70.9)
Malaise and fatigue	24 (100, 85.8–100)
Duration of initial phase^a (days)	7 (6.5–8.5, 5–10)
Number of hospitalized patients during initial phase	7 (29.2, 12.6–51.1)
Duration of hospitalization (days)	2 (1.5–4, 1–9)
Clinical presentation of meningoencephalitic phase
Meningitis	6 (25.0, 9.8–46.7)
Meningoencephalitis	14 (58.3, 36.6–77.9)
Meningoencephalomyelitis	4 (16.7, 4.7–37.4)
Number of hospitalized patients during meningoencephalitic phase	24 (100, 85.8–100)
Duration of hospitalization (days)	9 (7–13, 2–112)

^a Exact information available for 15 patients.

Table 2. Laboratory dynamics in 24 patients with the initial and meningoencephalitic phase of tick-borne encephalitis.

Laboratory parameters	Phase of illness
	Initial*	Meningoencephalitic**	p Value
Leukocytes (×10^9/L)	2.2 (1.0–8.9)^a	9.3 (5.9–18.6)	<.001
Decreased (<4.0)	19 (82.6%)	0	<.001
Elevated (>10.0)	0	10 (41.7%)	<.001
Platelets (×10^9/L)	113 (58–201)^a	266 (138–441)	<.001
Decreased (<140)	15 (65.2%)	1 (4.2%)	<.001
Elevated (>510)	0	0	NA
ALT (µkat/L)	0.14 (<0.10–3.11)	0.14 (<0.10–0.53)	.597
Elevated (≥0.57)	1 (4%)	0	>.999
AST (µkat/L)	0.68 (0.27–8.88)	0.34 (0.24–0.62)	<.001
Elevated (≥0.52)	20 (83%)	3 (12.5%)	<.001
CK (µkat/L)	0.94 (0.51–47.96)	0.63 (0.16–1.8)	.001
Elevated (≥2.41)	8^b (33%)	0	.004^c
Myoglobin (µg/L)	58 (14.8–629.7)^a	28 (12.8–87.3)	<.001
Elevated (≥107)	6^c (26.1%)	0	.009
Troponin (ng/L)	<10 (<10–33)^a	<10 (<10–44)	.853
Elevated (≥16)	5^d (21.7%)	5^e (21%)	>.999
At least one muscle enzyme elevated^f	10 (41.7%)	5^g (20.8%)	.213

ALT: alanine aminotransferase; AST: aspartate aminotransferase; CK: creatine kinase.

Data are shown as ratio (%) or median (interquartile range).

* Day of illness, when blood was collected: median 4.5 (IQR 3–6), range 2–8.

**Day of the second phase of illness, when blood was collected: median 2 (IQR 2–2), range 1–6.

^aData for 23 patients.

^bIn three out of eight patients, elevations were mild (>1–2 upper limit of normal, ULN), in three moderate(>2–3 ULN) and in three severe (>3 ULN).

^cIn two out of six patients, elevations were mild (>1–2 ULN), in three moderate (>2–3 ULN) and in one severe (>3 ULN).

^dIn three out of five patients elevations were mild (>1–2 ULN), in one moderate (>2–3 ULN).

^eIn three out of five patients elevations were mild (>1–2 ULN), in two moderate (>2–3 ULN).

^fCK, myoglobin, troponin.

^gOnly troponin.

Table 3. Laboratory dynamics in 24 patients with the initial and meningoencephalitic phase of tick-borne encephalitis.

Laboratory parameter	Number (%) of patients with >10% change in the ratio of levels (initial vs. meningoencephalitic phase)
	>10% decrease	>10% increase	p Value
Leukocytes (×10^9/L)	0^a	23 (100%)^a	<.001
Platelets (×10^9/L)	0^a	23 (100%)^a	<.001
ALT (µkat/L)	11 (45.8%)	8 (23.3%)	.555
AST (µkat/L)	21 (87.5%)	2 (8.3%)	<.001
CK (µkat/L)	19 (79.2%)	5 (20.8%)	<.001
Myoglobin (µg/L)	18 (78.3%)^a	3 (13.0%)^a	<.001
Troponin (ng/L)	4 (17.4%)^a	5 (21.7%)^a	>.999

ALT: alanine aminotransferase; AST: aspartate aminotransferase; CK: creatine kinase.

^a Data for 23 patients.