Serum Creatinine and Albumin Correlate with Survival in ALS

Michael Benatar, MD, MS, PhD

Serum creatinine and albumin as well as absolute lymphocyte count at the time of amyotrophic lateral sclerosis diagnosis correlate with 1-year survival.

The development of effective treatments for patients with amyotrophic lateral sclerosis (ALS) has proven to be immensely challenging. Among the many challenges to therapeutic development is the variability in the natural history of the disease, along with a paucity of biological markers that might forecast future prognosis. Factors previously shown to predict a poor outcome include a short latency from symptom onset to diagnosis, older age, female gender, bulbar (vs. limb) onset, and the presence of respiratory muscle weakness. Scientists have now investigated the utility of an array of routine hematological and biochemical factors at the time of ALS diagnosis in predicting 1-year survival in a population-based cohort of 639 patients and a validation cohort of 122 patients.

After Bonferroni correction for multiple comparisons, only serum albumin concentration, serum creatinine concentration, and absolute lymphocyte count (at a cutoff of 1700/μL) remained significantly associated with 1-year survival. In a multivariate model, the hazard ratio for death at 1 year after diagnosis with serum albumin ≤4.3 g/dL was 1.39 for men and 1.73 for women; HRs were 1.47 for men with serum creatinine concentration ≤0.82 mg/dL and 1.49 for women with serum creatinine ≤0.65 mg/dL. Notwithstanding these interesting observations, the positive predictive values of low serum albumin and low serum creatinine for 1-year mortality were only about 40% to 45%.

Citation(s):

Chiò A et al. Amyotrophic lateral sclerosis outcome measures and the role of albumin and creatinine: A population-based study. JAMA Neurol 2014 Jul 21; [e-pub ahead of print].