Assessment of muscle damage in patients with advanced Duchenne muscular dystrophy based on serum creatinine and the height-to-creatinine ratio.

BACKGROUND: Duchenne muscular dystrophy (DMD) is a fatal, X-linked neuromuscular disorder. This study investigated the correlation between serum markers and muscle damage in advanced DMD, retrospectively identified biochemical markers that reflect muscle damage in patients with advanced DMD, and provided a clinical basis for muscle assessment in advanced DMD. METHODS: We enrolled 70 male patients with DMD who were treated at the Affiliated Hospital of the Institute of Neurology, Anhui University of Chinese Medicine, between January 2018 and December 2025. They were divided into an advanced group (≥12 years) and a non-advanced group (<12 years) based on age. We compared differences in serum creatinine (Scr), height-to-creatinine ratio, and creatine kinase (CK) levels between the two groups and used Spearman's rank correlation analysis to assess the association between these indicators and muscle damage. RESULTS: The levels of Scr and CK in the advanced group were lower than those in the non-advanced group, while the height-to-creatinine ratio was higher (P < 0.05). The results of Spearman's rank correlation analysis showed that Scr levels in late-stage DMD were significantly correlated with magnetic resonance imaging (MRI) muscle damage scores (r = -0.522, P = 0.003), while the height-to-creatinine ratio was significantly positively correlated with MRI scores (r = 0.52, P = 0.003). Results of multiple linear regression analysis showed that Scr (B = -0.056, P < 0.001) and the height-to-creatinine ratio (B = -0.018, P = 0.047) were independent predictors of the degree of muscle damage in patients with advanced DMD. Scr exhibited the strongest effect (standardized β = -1.007), with an adjusted R 2 of 0.375. CONCLUSION: Scr reflects changes in total skeletal muscle mass in patients with advanced DMD. In conjunction with the height-to-creatinine ratio, these parameters provide an assessment indicator for skeletal muscle damage.