Serum Creatine Levels as a Predictive Factor for Postoperative Cerebrovascular Events in Patients With Moyamoya
Siqi Mou1,2, Zhikang Zhao1,3, Chenglong Liu1,3
1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Lower serum creatine levels in moyamoya disease (MMD) patients correlate with increased risk of postoperative cerebrovascular events. Creatine supplementation may help prevent these adverse outcomes.
Area of Science:
- Biochemistry and Neurology
- Vascular Surgery
Background:
- Creatine is vital for cellular energy metabolism.
- The link between creatine and cerebrovascular disease, particularly in moyamoya disease (MMD), remains under-investigated.
- This study focuses on serum creatine levels and their association with postoperative cerebrovascular events in MMD patients.
Purpose of the Study:
- To investigate the relationship between preoperative serum creatine levels and the occurrence of postoperative cerebrovascular events in patients with moyamoya disease (MMD).
- To identify potential predictive markers for cerebrovascular events following MMD surgery.
Main Methods:
- Serum creatine and disodium creatine phosphate levels were measured in 352 MMD patients using liquid chromatography-tandem mass spectrometry.
- Kaplan-Meier curves and Cox regression analyses were employed to assess the impact of serum creatine on cerebrovascular event risk and identify predictors.
- A prognostic nomogram was developed to predict stroke-free survival postoperatively.
Main Results:
- Serum creatine levels negatively correlated with creatinine and homocysteine.
- Patients with higher serum creatine concentrations exhibited a significantly lower risk of postoperative cerebrovascular events compared to those with lower levels (HR: 0.55, p=0.026).
- Analysis by tertiles confirmed that the highest creatine group had a reduced risk versus the lowest group (p=0.04).
Conclusions:
- Preoperative serum creatine levels are inversely associated with the risk of postoperative cerebrovascular events in MMD patients.
- Lower serum creatine may indicate a higher risk, suggesting potential benefits of creatine supplementation for stroke prevention in this population.
Background:
Creatine is essential for energy storage and transfer within and outside cells. However, its relationship with cerebrovascular disease has not been fully explored. This study examined the association between serum creatine levels and postoperative cerebrovascular events, including transient ischemic attack (TIA), ischemic stroke, and hemorrhagic stroke, in patients with moyamoya disease (MMD).
Methods:
Serum creatine and disodium creatine phosphate levels were quantified in 352 patients with MMD using liquid chromatography-tandem mass spectrometry. Kaplan-Meier (KM) curves were used to analyze the impact of serum creatine levels on cerebrovascular event risk, whereas univariate and multivariate Cox regression analyses were used to identify predictors of postoperative outcomes. A prognostic nomogram was developed to predict stroke-free survival at 12, 24, and 36 months postoperatively.
Results:
In patients with MMD, serum creatine showed a negative correlation with creatinine (r = -0.22; p < 0.001) and homocysteine (r = -0.10; p < 0.05) but not with disodium creatine phosphate (r = -0.08; p = 0.15). When patients were divided into high and low groups based on the median serum creatine concentration, KM curve analysis revealed that patients in the high concentration group had a lower relative risk of cerebrovascular events than those in the low concentration group (hazard ratio: 0.55; 95% confidence interval, 0.33-0.94; p = 0.026). Furthermore, when patients were categorized into three levels based on creatine concentration, the overall KM curve analysis showed a significant difference (p = 0.038), such that the highest creatine concentration group (third tertile) showed a significantly reduced risk compared with the lowest concentration group (first tertile; p = 0.04).
Conclusion:
Lower preoperative serum creatine levels were associated with a higher risk of postoperative cerebrovascular events in patients with MMD. Therefore, creatine supplementation may be an effective means of preventing adverse outcomes in patients with MMD.
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