gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Decreased antioxidant status in aneurysmal subarachnoid haemorrhage correlates with poor neurological outcome

Reduzierter antioxidativer Status bei der aneurysmatischen Subarachnoidalblutung korreliert mit einem schlechten klinischen Outcome

Meeting Abstract

  • Naureen Keric - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Jan Schmitt - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Christina Frenz - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Julia Masomi-Bornwasser - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Harald Krenzlin - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Johannes Lotz - Universitätsmedizin Mainz, Institut für klinische Chemie und Laboratoriumsmedizin, Mainz, Deutschland
  • Florian Ringel - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Thomas Kerz - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV278

doi: 10.3205/19dgnc297, urn:nbn:de:0183-19dgnc2970

Published: May 8, 2019

© 2019 Keric et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Subarachnoid hemorrhage (SAH) is a devastating illness with high morbidity and mortality. Free radical induced lipid peroxidation, e.g. oxidative stress, has also been identified as a potentially important contributor to vasospasm (VS) and the final cascade of ischemic cell death. The aim of this study was to evaluate the antioxidant status and its possible impact on neurological outcome in aneurysmal SAH patients.

Methods: In this prospective observational study 28 aneurysmal SAH patients were included (mean age 54.7±12.7 y). Blood and cerebrospinal fluid (CSF) samples were collected on day (d) 1, 3, 7 and 10. 24 patients (mean age 59.1±13.7 y) with different neurosurgical diagnoses served as controls. The oxidative stress was measured by glutathione peroxidase (GPx; U/l) and total and free glutathione-sulfhydryl (GSH; mg/l) in seru, as well as by malondealdehyde (MDA,µg/l), superoxide dismutase (SOD,U/ml), and total antioxidant status (TAS,µmol/l) in serum and CSF. Clinical data (mRS, GOSE).were assessed on admission (Hunt&Hess grade, Fisher grade, GCS), after 6 weeks (6w) and 6 months (6m).

Results: Initial GPx levels were similar in SAH and control group (C) (SAH: 2125±534.8; C:2257±711.4), while it decreased till d10 (1908±392.4; P=0.003). Total and free GSH values declined from d1 to d10 (Total GSH: 80.9±24.9 to 73.3±26.2; C: 83.2±17.9; free GSH: 71.1±25.5 to 63.5±25.4; C: 78.8±21.1). The d1 TAS was higher in SAH serum (83.4±46.7; C: 48.6±33.3) and similar in CSF (225.1±82.2; C: 220.2±80.7) and lowered on d3 in CSF (182.8±82.5). SOD values increased from d1 to 3 in serum and CSF (serum: 1.3±0.7 to 1.5±0.9; CSF: 1.7±1.7 to 2.4±2.4; C serum: 1.3±0.5; C CSF: 1.9±1.0). MDA in CSF increased from d1 to d3 (6.4±2.5 to 7.8±5.3; C: 7.4±4.1). Lower SOD values in d1 CSF correlated with higher Hunt&Hess grade (r=0.4; P=0.03) and higher mRS (6w: r=0.4; P=0.02; 6m: r=0.4; P=0.04). Higher d1 MDA levels correlated with a higher Fisher grade (r=-0.5; P=0.02), and likewise with a poorer outcome (GOSE 6w: r=-0.4; P=0.02; mRS 6m: r=0.5; P=0.02). Lower serum TAS values correlated with lower GCS (r=-0.4; P=0.04) on admission and a worse GOSE 6w (r=-0.4; P=0.047).

Conclusion: In our study a reduction of the antioxidative enzyme SOD and the TAS were associated with a poorer neurological outcome after 6 weeks and 6 months. Ongoing radiographic and Doppler investigation analysis will reveal its role on symptomatic VS. As a result new treatment strategies targeting oxidative stress need to be evaluated.