Work

Serum Creatine Levels as a Predictive Factor for Postoperative Cerebrovascular Events in Patients With Moyamoya Disease

Year: 2025

Type: article

Abstract: 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.

Source: Brain and Behavior

DOI: 10.1002/brb3.70331