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Published in: Annals of Intensive Care 1/2016

Open Access 01-12-2016 | Research

Association between total antioxidant capacity and mortality in ischemic stroke patients

Authors: Leonardo Lorente, María M. Martín, Antonia Pérez-Cejas, Pedro Abreu-González, Luis Ramos, Mónica Argueso, Juan J. Cáceres, Jordi Solé-Violán, Alejandro Jiménez

Published in: Annals of Intensive Care | Issue 1/2016

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Abstract

Objective

Data on circulating total antioxidant capacity (TAC) levels in ischemic stroke patients compared with healthy controls are limited and provided conflicting findings. There are not data about the association between circulating TAC levels, peroxidation state and outcome in patients with severe ischemic stroke. The objective of this study was to examine the relationship of TAC with 30-day mortality after severe ischemic stroke.

Methods

This multicenter study included 58 patients with coma (Glasgow Coma Scale < 9) following severe malignant middle cerebral artery infarction (MMCAI). We measured circulating levels of TAC and malondialdehyde (MDA, a biomarker of lipid peroxidation) on day 1 of severe MMCAI diagnosis. The study endpoint was 30-day mortality.

Results

Non-survivors (n = 29) showed higher serum TAC levels (p < 0.001) and higher serum MDA levels (p = 0.004) than survivors (n = 29). Multiple binomial logistic regression analysis showed that serum TAC levels were associated with 30-day mortality, after controlling for Glasgow Coma Scale and age (odds ratio 1.92; 95 % confidence interval 1.201–3.072; p = 0.006). There was a correlation between serum TAC and MDA levels (rho = 0.35; p = 0.008).

Conclusions

This single-center study in severe MMCAI patients found an association between higher serum TAC levels and 30-day mortality and further identified a relationship between serum TAC levels, lipid peroxidation state and mortality after severe ischemic stroke.
Literature
1.
go back to reference Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al, American Heart Association, American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–11. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al, American Heart Association, American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007;38:1655–11.
3.
go back to reference Radak D, Resanovic I, Isenovic ER. Link between oxidative stress and acute brain ischemia. Angiology. 2014;65:667–76.CrossRefPubMed Radak D, Resanovic I, Isenovic ER. Link between oxidative stress and acute brain ischemia. Angiology. 2014;65:667–76.CrossRefPubMed
4.
go back to reference Rodrigo R, Fernández-Gajardo R, Gutiérrez R, Matamala JM, Carrasco R, Miranda-Merchak A, et al. Oxidative stress and pathophysiology of ischemic stroke: novel therapeutic opportunities. CNS Neurol Disord Drug Targets. 2013;12:698–714.CrossRefPubMed Rodrigo R, Fernández-Gajardo R, Gutiérrez R, Matamala JM, Carrasco R, Miranda-Merchak A, et al. Oxidative stress and pathophysiology of ischemic stroke: novel therapeutic opportunities. CNS Neurol Disord Drug Targets. 2013;12:698–714.CrossRefPubMed
5.
go back to reference Manzanero S, Santro T, Arumugam TV. Neuronal oxidative stress in acute ischemic stroke: sources and contribution to cell injury. Neurochem Int. 2013;62:712–8.CrossRefPubMed Manzanero S, Santro T, Arumugam TV. Neuronal oxidative stress in acute ischemic stroke: sources and contribution to cell injury. Neurochem Int. 2013;62:712–8.CrossRefPubMed
6.
go back to reference Pradeep H, Diya JB, Shashikumar S, Rajanikant GK. Oxidative stress—assassin behind the ischemic stroke. Folia Neuropathol. 2012;50:219–30.CrossRefPubMed Pradeep H, Diya JB, Shashikumar S, Rajanikant GK. Oxidative stress—assassin behind the ischemic stroke. Folia Neuropathol. 2012;50:219–30.CrossRefPubMed
7.
go back to reference Olmez I, Ozyurt H. Reactive oxygen species and ischemic cerebrovascular disease. Neurochem Int. 2012;60:208–12.CrossRefPubMed Olmez I, Ozyurt H. Reactive oxygen species and ischemic cerebrovascular disease. Neurochem Int. 2012;60:208–12.CrossRefPubMed
8.
go back to reference Warner DS, Sheng H, Batinić-Haberle I. Oxidants, antioxidants and the ischemic brain. J Exp Biol. 2004;207:3221–31.CrossRefPubMed Warner DS, Sheng H, Batinić-Haberle I. Oxidants, antioxidants and the ischemic brain. J Exp Biol. 2004;207:3221–31.CrossRefPubMed
9.
go back to reference Ghiselli A, Serafini M, Natella F, Scaccini C. Total antioxidant capacity as a tool to assess redox status: critical view and experimental data. Free Radic Biol Med. 2000;29:1106–14.CrossRefPubMed Ghiselli A, Serafini M, Natella F, Scaccini C. Total antioxidant capacity as a tool to assess redox status: critical view and experimental data. Free Radic Biol Med. 2000;29:1106–14.CrossRefPubMed
10.
go back to reference Cojocaru IM, Cojocaru M, Sapira V, Ionescu A. Evaluation of oxidative stress in patients with acute ischemic stroke. Rom J Intern Med. 2013;51:97–106.PubMed Cojocaru IM, Cojocaru M, Sapira V, Ionescu A. Evaluation of oxidative stress in patients with acute ischemic stroke. Rom J Intern Med. 2013;51:97–106.PubMed
11.
go back to reference Ciancarelli I, De Amicis D, Di Massimo C, Carolei A, Ciancarelli MG. Oxidative stress in post-acute ischemic stroke patients after intensive neurorehabilitation. Curr Neurovasc Res. 2012;9:266–73.CrossRefPubMed Ciancarelli I, De Amicis D, Di Massimo C, Carolei A, Ciancarelli MG. Oxidative stress in post-acute ischemic stroke patients after intensive neurorehabilitation. Curr Neurovasc Res. 2012;9:266–73.CrossRefPubMed
12.
go back to reference Lagowska-Lenard M, Stelmasiak Z, Bartosik-Psujek H. Influence of vitamin C on markers of oxidative stress in the earliest period of ischemic stroke. Pharmacol Rep. 2010;62:751–6.CrossRefPubMed Lagowska-Lenard M, Stelmasiak Z, Bartosik-Psujek H. Influence of vitamin C on markers of oxidative stress in the earliest period of ischemic stroke. Pharmacol Rep. 2010;62:751–6.CrossRefPubMed
13.
go back to reference Yang TH, Chang CY, Hu ML. Various forms of homocysteine and oxidative status in the plasma of ischemic-stroke patients as compared to healthy controls. Clin Biochem. 2004;37:494–9.CrossRefPubMed Yang TH, Chang CY, Hu ML. Various forms of homocysteine and oxidative status in the plasma of ischemic-stroke patients as compared to healthy controls. Clin Biochem. 2004;37:494–9.CrossRefPubMed
14.
go back to reference Altamura C, Squitti R, Pasqualetti P, Gaudino C, Palazzo P, Tibuzzi F, et al. Ceruloplasmin/transferrin system is related to clinical status in acute stroke. Stroke. 2009;40:1282–8.CrossRefPubMed Altamura C, Squitti R, Pasqualetti P, Gaudino C, Palazzo P, Tibuzzi F, et al. Ceruloplasmin/transferrin system is related to clinical status in acute stroke. Stroke. 2009;40:1282–8.CrossRefPubMed
15.
go back to reference Guldiken B, Demir M, Guldiken S, Turgut N, Turgut B, Tugrul A. Oxidative stress and total antioxidant capacity in diabetic and nondiabetic acute ischemic stroke patients. Clin Appl Thromb Hemost. 2009;15:695–700.CrossRefPubMed Guldiken B, Demir M, Guldiken S, Turgut N, Turgut B, Tugrul A. Oxidative stress and total antioxidant capacity in diabetic and nondiabetic acute ischemic stroke patients. Clin Appl Thromb Hemost. 2009;15:695–700.CrossRefPubMed
16.
go back to reference Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81–4.CrossRefPubMed Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81–4.CrossRefPubMed
17.
go back to reference Lorente L, Martín MM, Abreu-González P, Ramos L, Argueso M, Solé-Violán J, Riaño-Ruiz M, Jiménez A. Serum malondialdehyde levels in patients with malignant middle cerebral artery infarction are associated with mortality. PLoS One. 2015;10:e0125893.CrossRefPubMedPubMedCentral Lorente L, Martín MM, Abreu-González P, Ramos L, Argueso M, Solé-Violán J, Riaño-Ruiz M, Jiménez A. Serum malondialdehyde levels in patients with malignant middle cerebral artery infarction are associated with mortality. PLoS One. 2015;10:e0125893.CrossRefPubMedPubMedCentral
18.
go back to reference Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed
19.
go back to reference Draper HH, Hadley M. Malondialdehyde determination as index of lipid peroxidation. Methods Enzymol. 1990;186:421–31.CrossRefPubMed Draper HH, Hadley M. Malondialdehyde determination as index of lipid peroxidation. Methods Enzymol. 1990;186:421–31.CrossRefPubMed
20.
go back to reference Kikugawa K, Kojima T, Yamaki S, Kosugi H. Interpretation of the thiobarbituric acid reactivity of rat liver and brain homogenates in the presence of ferric ion and ethylenediaminetetraacetic acid. Anal Biochem. 1992;202:249–55.CrossRefPubMed Kikugawa K, Kojima T, Yamaki S, Kosugi H. Interpretation of the thiobarbituric acid reactivity of rat liver and brain homogenates in the presence of ferric ion and ethylenediaminetetraacetic acid. Anal Biochem. 1992;202:249–55.CrossRefPubMed
21.
go back to reference Lorente L, Martín MM, Almeida T, Abreu-González P, Ferreres J, Solé-Violán J, et al. Association between serum total antioxidant capacity and mortality in severe septic patients. J Crit Care. 2015;30:217.e7–12.CrossRef Lorente L, Martín MM, Almeida T, Abreu-González P, Ferreres J, Solé-Violán J, et al. Association between serum total antioxidant capacity and mortality in severe septic patients. J Crit Care. 2015;30:217.e7–12.CrossRef
22.
go back to reference Lorente L, Martín MM, Almeida T, Abreu-González P, Ramos L, Argueso M, et al. Total antioxidant capacity is associated with mortality of patients with severe traumatic brain injury. BMC Neurol. 2015;15:115.CrossRefPubMedPubMedCentral Lorente L, Martín MM, Almeida T, Abreu-González P, Ramos L, Argueso M, et al. Total antioxidant capacity is associated with mortality of patients with severe traumatic brain injury. BMC Neurol. 2015;15:115.CrossRefPubMedPubMedCentral
23.
go back to reference Fulia F, Gitto E, Cuzzocrea S, Reiter RJ, Dugo L, Gitto P, Barberi S, Cordaro S, Barberi I. Increased levels of malondialdehyde and nitrite/nitrate in the blood of asphyxiated newborns: reduction by melatonin. J Pineal Res. 2001;31:343–9.CrossRefPubMed Fulia F, Gitto E, Cuzzocrea S, Reiter RJ, Dugo L, Gitto P, Barberi S, Cordaro S, Barberi I. Increased levels of malondialdehyde and nitrite/nitrate in the blood of asphyxiated newborns: reduction by melatonin. J Pineal Res. 2001;31:343–9.CrossRefPubMed
24.
go back to reference Gitto E, Karbownik M, Reiter RJ, Tan DX, Cuzzocrea S, Chiurazzi P, Cordaro S, Corona G, Trimarchi G, Barberi I. Effects of melatonin treatment in septic newborns. Pediatr Res. 2001;50:756–60.CrossRefPubMed Gitto E, Karbownik M, Reiter RJ, Tan DX, Cuzzocrea S, Chiurazzi P, Cordaro S, Corona G, Trimarchi G, Barberi I. Effects of melatonin treatment in septic newborns. Pediatr Res. 2001;50:756–60.CrossRefPubMed
25.
go back to reference Sahib AS, Al-Jawad FH, Alkaisy AA. Effect of antioxidants on the incidence of wound infection in burn patients. Ann Burns Fire Disasters. 2010;23:199–205.PubMedPubMedCentral Sahib AS, Al-Jawad FH, Alkaisy AA. Effect of antioxidants on the incidence of wound infection in burn patients. Ann Burns Fire Disasters. 2010;23:199–205.PubMedPubMedCentral
26.
go back to reference Saniova B, Drobny M, Lehotsky J, Sulaj M, Schudichova J. Biochemical and clinical improvement of cytotoxic state by amantadine sulphate. Cell Mol Neurobiol. 2006;26:1475–82.CrossRefPubMed Saniova B, Drobny M, Lehotsky J, Sulaj M, Schudichova J. Biochemical and clinical improvement of cytotoxic state by amantadine sulphate. Cell Mol Neurobiol. 2006;26:1475–82.CrossRefPubMed
27.
go back to reference Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation with or without B-group vitamins after acute ischemic stroke: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2006;30:108–14.CrossRefPubMed Ullegaddi R, Powers HJ, Gariballa SE. Antioxidant supplementation with or without B-group vitamins after acute ischemic stroke: a randomized controlled trial. JPEN J Parenter Enteral Nutr. 2006;30:108–14.CrossRefPubMed
28.
go back to reference Walcott BP, Kuklina EV, Nahed BV, George MG, Kahle KT, Simard JM, et al. Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals. PLoS One. 2011;6:e29193.CrossRefPubMedPubMedCentral Walcott BP, Kuklina EV, Nahed BV, George MG, Kahle KT, Simard JM, et al. Craniectomy for malignant cerebral infarction: prevalence and outcomes in US hospitals. PLoS One. 2011;6:e29193.CrossRefPubMedPubMedCentral
29.
go back to reference Bar M, Mikulik R, Skoloudik D, Czerny D, Lipina R, Sames M, et al. Decompressive surgery for malignant supratentorial infarction remains underutilized after guideline publication. J Neurol. 2011;258:1689–94.CrossRefPubMed Bar M, Mikulik R, Skoloudik D, Czerny D, Lipina R, Sames M, et al. Decompressive surgery for malignant supratentorial infarction remains underutilized after guideline publication. J Neurol. 2011;258:1689–94.CrossRefPubMed
30.
go back to reference Suyama K, Horie N, Hayashi K, Nagata I. Nationwide survey of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Japan. World Neurosurg. 2014;82(6):1158–63.CrossRefPubMed Suyama K, Horie N, Hayashi K, Nagata I. Nationwide survey of decompressive hemicraniectomy for malignant middle cerebral artery infarction in Japan. World Neurosurg. 2014;82(6):1158–63.CrossRefPubMed
Metadata
Title
Association between total antioxidant capacity and mortality in ischemic stroke patients
Authors
Leonardo Lorente
María M. Martín
Antonia Pérez-Cejas
Pedro Abreu-González
Luis Ramos
Mónica Argueso
Juan J. Cáceres
Jordi Solé-Violán
Alejandro Jiménez
Publication date
01-12-2016
Publisher
Springer Paris
Published in
Annals of Intensive Care / Issue 1/2016
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-016-0143-7

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