Blood biomarkers and prognosis of amyotrophic lateral sclerosis

The objective was to assess the ability of eight commonly measured blood markers to serve as prognostic biomarkers in amyotrophic lateral sclerosis (ALS).

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.

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.

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.