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685, 95% confidence interval [CI] 0.616-0.754, p=0.039; pTau/tTau ratio AUC 0.777, 95% CI 0.707-0.848, p0.001). Among ALS patients, increased tTau levels were associated with advanced age of onset, increased revised amyotrophic lateral sclerosis functional rating scale (ALSFRS-R) score (ΔFS) rate of progression, and spinal onset. Multivariate analysis showed that in ALS patients, this biomarker was an independent negative predictor of overall survival. Our findings suggest that tTau and pTau/tTau ratio can be diagnostic biomarkers of ALS. In add