Decreased serum creatinine levels predict short survival in amyotrophic lateral sclerosis

Objective: To explore the associations between serum creatinine and creatine kinase (CK) levels with survival in male and female ALS patients. Methods: A prospective cohort study was carried out including 346 ALS patients with repeated serum creatinine and CK measurements. Kaplan Meier analysis and multivariable Cox regression were used to perform survival analysis. Results: There were 218 male and 128 female patients, and the males had significantly higher baseline serum creatinine and CK levels than females. After multivariable Cox regression analysis, lower baseline serum creatinine levels were associated with a short survival in both male (<= 61 mu mol/L, HR: 1.629; 95%CI: 1.1682.273) and female ALS patients (<= 52 mu mol/L, HR: 1.677; 95%CI: 1.042-2.699), whereas, the serum CK levels were not correlated with survival. Besides, creatinine levels were positively associated with ALSFRS-R scores, and inversely with the decline rate of ALSFRS-R per month. During follow-up, serum creatinine levels tended to be decreased along with the disease progression, and the higher decline rate of creatinine per month (>1.5) showed significantly shorter survival, compared to the lower group (<= 1.5) (30.0 months vs. 65.0 months, Chi square = 28.25, P < 0.0001). Interpretation: Serum creatinine could be a reliable and easily accessible prognostic chemical marker for ALS, and decreased baseline creatinine levels could predict a poor prognosis and a short survival in both male and female ALS patients.