Blood biomarkers and prognosis of amyotrophic lateral sclerosis

Abstract

Background and purpose: The objective was to assess the ability of eight commonly measured blood markers to serve as prognostic biomarkers in amyotrophic lateral sclerosis (ALS). Methods: A cohort study was conducted of 399 individuals with newly diagnosed ALS between 2006 and 2011 in Stockholm, Sweden. Information on eight blood markers, including creatinine, albumin, haemoglobin, C-reactive protein (CRP), glucose, potassium, sodium and calcium, measured at or after the date of ALS diagnosis, was collected. The Cox regression model and joint model were used to explore the associations between biomarkers and risk of mortality. Results: The mean age at ALS diagnosis was 66.25 years and 58% of the patients were male. A lower than median level of serum creatinine [hazard ratio (HR) 1.67; 95% confidence interval (CI) 1.31-2.12] or albumin (HR 1.49, 95% CI 1.13-1.96) whereas a higher than median level of log-transformed CRP (HR 1.33, 95% CI 1.04-1.71) or glucose (HR 1.34, 95% CI 1.01-1.78) at baseline was associated with a higher mortality risk. Taking all available measurements after ALS diagnosis into account, an association was found between per standard deviation (SD) decrease in serum creatinine (HR 2.23, 95% CI 1.81-2.75) or albumin (HR 1.83, 95% CI 1.43-2.36) as well as per SD increase of log(CRP) (HR 1.96, 95% CI 1.58-2.43) or glucose (HR 1.61, 95% CI 1.21-2.12) and a higher mortality risk. No clear association was found for haemoglobin, potassium, sodium or calcium. Conclusions: This study suggests that serum creatinine, albumin, CRP and glucose measured at the time of ALS diagnosis as well as their temporal changes after ALS diagnosis could serve as additional prognostic biomarkers for ALS. Their values in routine clinical practice and clinical trials of ALS need to be investigated further.

Creatinine and C-reactive protein in amyotrophic lateral sclerosis, multiple sclerosis and Parkinson’s disease

“…Another study showed a positive association between C-reactive protein levels and disease progression among patients with amyotrophic lateral sclerosis ( Lunetta et al , 2017 ). Our recent study also found an association between increasing level of C-reactive protein and a higher mortality among patients with amyotrophic lateral sclerosis, further strengthening the prognostic value of C-reactive protein in amyotrophic lateral sclerosis ( Sun et al , 2020 ).…”

“…Taken together, serum creatinine might be an important biomarker in monitoring disease course before symptom onset, for example among high-risk individuals. Finally, because both our latest study and previous studies have suggested an inverse relationship between creatinine level and amyotrophic lateral sclerosis progression ( Chio et al , 2014 ; Lanznaster et al , 2019 ; Sun et al , 2020 ) and proposed creatinine as a potential biomarker to assess treatment effects in amyotrophic lateral sclerosis clinical trials ( van Eijk et al , 2018 ), the clinical use of serum creatinine as a biomarker for diagnosis and prognosis prediction of amyotrophic lateral sclerosis needs to be further discussed.…”

Preoperative fibrinogen-to-albumin ratio, a potential prognostic factor for patients with stage IB-IIA cervical cancer

“…Albumin (Alb) and fibrinogen (Fib) are two commonly used circulating inflammatory proteins. Alb has been reported to be a well-established prognostic factor in patients with various diseases, including oral cavity cancer [10], metastatic pathological femur fractures [11], and amyotrophic lateral sclerosis [12]. Moreover, the prognostic role of Fib has also been reported in various studies, such as spontaneous intracerebral haemorrhage [13] and surgically resected non-small-cell lung cancer [14].…”

The prognostic value of sarcopenia combined with preoperative fibrinogen–albumin ratio in patients with intrahepatic cholangiocarcinoma after surgery: A multicenter, prospective study

“…Recent studies reported that albumin was associated with the prognosis of many diseases, such as Oral Cavity cancer, 11 metastatic pathological femur fractures, 12 and amyotrophic lateral sclerosis. 13 Besides, previous studies showed that fibrinogen has the function of predicting the prognosis of diseases, such as spontaneous cerebral hemorrhage 14 and renal cancer. 15 More and more studies have shown that high fibrinogen and low albumin are correlated with poor prognosis in cancer patients.…”