To systematically evaluate and quantify the prognostic value of baseline serum creatinine and albumin levels in patients with ALS.

Nutritional and metabolic alterations are increasingly recognized as contributors to disease progression in amyotrophic lateral sclerosis (ALS). Circulating biomarkers such as creatinine and albumin may reflect systemic metabolism, muscle mass, and inflammation, offering potential prognostic value. However, their predictive role in survival across studies has remained uncertain.

A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Embase, and Web of Science were searched from inception to October 2025 using terms related to “amyotrophic lateral sclerosis,” “creatinine,” “albumin,” and “prognosis.” Observational studies reporting hazard ratios (HRs) or risk estimates for survival in relation to baseline biomarker levels were included. Data were extracted independently by two reviewers. Random-effects meta-analyses were performed, and heterogeneity was assessed using the I² statistic.

From 417 identified records, 8 studies met inclusion criteria, encompassing >2,800 ALS patients with follow-up periods ranging from 12 to 60 months. Pooled analysis showed that lower baseline creatinine levels were significantly associated with shorter overall survival (pooled HR = 1.54, 95% CI 1.31–1.82, I² = 41%). In contrast, albumin levels demonstrated a moderate but nonsignificant association after adjustment for confounders (pooled HR = 1.12, 95% CI 0.93–1.35, I² = 56%). Sensitivity analyses confirmed robustness of the creatinine results. No major publication bias was detected.