Image: Histology of amyotrophic lateral sclerosis showing markedly degenerated anterior spinal nerve root (cross section) with extensive demyelination (Photo courtesy of Dr. Hidehiro Takei, MD).
Various biological markers have been proposed as potentially related to a better amyotrophic lateral sclerosis (ALS) outcome including dyslipidemia, elevated levels of uric acid, and creatinine, and reduced granulocyte count.
The blood biomarkers serum albumin and creatinine appear to be associated with survival in patients with ALS and may help define prognosis in patients after they are diagnosed with the fatal neurodegenerative disorder commonly known as Lou Gehrig disease.
Neuroscientists from the University of Turin (Italy) examined blood markers at ALS diagnosis in population-based group of 712 patients, the discovery cohort in Italy, and then replicated the findings in another group of 122 patients, the validation cohort, from an ALS tertiary center. The following biomarkers were investigated and correlated with survival: total leukocytes, neutrophils, lymphocytes, monocytes, glucose, creatinine, uric acid, albumin, bilirubin, total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, creatine kinase, thyroid-stimulating hormones, and erythrocyte sedimentation rate.
The team reported significant differences in patients whose serum albumin was less than or equal to 4.3 mg/dL; creatinine levels in men of less than or equal 0.82 mg/dL, while in women creatinine levels less than or equal 0.65 mg/dL; and lymphocyte count in both sexes of less than or equal to 1,700/μL. These results were significantly associated with ALS outcome in both sexes with a dose-response effect with better survival with increasing levels. These findings were confirmed in the validation cohort. In patients with ALS, serum albumin was correlated with markers of inflammatory state while serum creatinine was correlated with fat-free mass, which is a marker of muscle mass.
The authors concluded that both creatinine and albumin are reliable and easily detectable blood markers of the severity of motor dysfunction in ALS and could be used in defining patients' prognosis at the time of diagnosis. Longitudinal studies on the variations in serum albumin and creatinine levels and their relationships to clinical status will help determine whether and how these clinical chemical factors vary during the progression of the disease. The study was published on July 21, 2014, in the journal JAMA Neurology.
University of Turin