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

## TL;DR

Lower preoperative creatine levels in moyamoya disease patients are linked to higher postoperative cerebrovascular event risks, suggesting creatine supplementation may help prevent these events.

## Contribution

This study identifies serum creatine as a novel predictive biomarker for postoperative cerebrovascular events in moyamoya disease patients.

## Key findings

- Lower serum creatine levels correlated with higher cerebrovascular event risk in moyamoya disease patients.
- A prognostic nomogram was developed to predict stroke-free survival at 12, 24, and 36 months post-surgery.
- Creatine supplementation may reduce postoperative cerebrovascular risks in moyamoya disease patients.

## Abstract

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).

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.

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).

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.

This study of 352 moyamoya disease patients revealed that lower preoperative serum creatine levels are significantly associated with an increased risk of postoperative cerebrovascular events. Furthermore, a prognostic model was developed to predict stroke‐free survival over 12–36 months. These findings raise the possibility that creatine supplementation could be beneficial in reducing postoperative cerebrovascular risk, warranting further investigation.