Creatinine as a predictor of muscle mass deficiency in patients with severe cerebral palsy

   Energy processes in muscles can be reflected by the creatine phosphokinase system of ATP resynthesis from ADP and creatine phosphate. The product of non-enzymatic degradation of creatine (creatine phosphate) is creatinine, which accumulates in the blood serum, and its concentration correlates with the volume of the patient’s muscle tissue, subject to the normal functioning of the kidneys.

   Purpose. To assess the perioperative serum creatinine level as a biological marker of muscle mass in patients with severe forms of cerebral palsy, IV–V level according to GMFCS, during orthopedic interventions on the hip joint.

   Material and methods. A prospective clinical observational study included 82 patients with severe forms of cerebral palsy, spastic dislocations (subluxations) of the hips, for which reconstructive or palliative interventions were performed on the hip joints. The trophological status of children was assessed before surgery, the level of serum creatinine was determined in the intraoperative period, on the first postoperative day, and on the fifth day after surgery.

   Results. The circumference of the middle third of the shoulder in 28 % of patients, as well as the thickness of the skin-fat fold over the triceps in 61 % of children were below the 10^th centile, which was regarded as malnutrition. The calculated proportion of body fat equal to 10 [8; 20] % in combination with the circumference of the muscles of the middle third of the shoulder suggest a combination of protein-energy deficiency and muscle mass deficiency in 1/5 of the patients. Creatinine indicators at all stages of observation corresponded to the minimum age norm or were below these values, tended to decrease and had a random agreement (W = 0,129).

   Conclusion. The level of creatinine in the blood serum correlates with the «shoulder muscle circumference» parameter in children with severe forms of cerebral palsy, severe movement disorders of IV–V level according to GMFCS. Plasma creatinine can be used as a biological marker of skeletal muscle mass in patients with severe cerebral palsy.

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