Elevation of serum lactate dehydrogenase at posterior reversible encephalopathy syndrome onset in chemotherapy-treated cancer patients.
The pathophysiology of posterior reversible encephalopathy syndrome (PRES) is incompletely understood; however, an underlying state of immune dysregulation and endothelial dysfunction has been proposed. We examined alterations of serum lactate dehydrogenase (LDH), a marker of endothelial dysfunction, relative to the development of PRES in patients receiving chemotherapy. A retrospective Institutional Review Board approved database of 88 PRES patients was examined. PRES diagnosis was confirmed by congruent clinical diagnosis and MRI. Clinical features at presentation were recorded. Serum LDH values were collected at three time points: prior to, at the time of, and following PRES diagnosis. Student's t-test was employed. LDH values were available during the course of treatment in 12 patients (nine women; mean age 57.8 years [range 33-75 years]). Chemotherapy-associated PRES patients were more likely to be normotensive (25%) versus the non-chemotherapy group (9%). LDH levels at the time of PRES diagnosis were higher than those before and after (p=0.0263), with a mean difference of 114.8 international units/L. Mean time intervals between LDH measurement prior to and following PRES diagnosis were 44.8 days and 51.4 days, respectively. Mean elapsed time between last chemotherapy administration and PRES onset was 11.1days. In conclusion, serum LDH, a marker of endothelial dysfunction, shows statistically significant elevation at the onset of PRES toxicity in cancer patients receiving chemotherapy. Our findings support a systemic process characterized by endothelial injury/dysfunction as a factor, if not the prime event, in the pathophysiology of PRES.
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA. Electronic address: fitzgeraldryant@uams.edu.
Ryan T
RT
Fitzgerald
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA.
Steven M
SM
Wright
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA.
Rohan S
RS
Samant
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA.
Manoj
M
Kumar
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA.
Raghu H
RH
Ramakrishnaiah
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA.
Rudy
R
Van Hemert
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA.
Aliza T
AT
Brown
Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham Street, #556, Little Rock, AR 72205-7199, USA.
Edgardo J
EJ
Angtuaco
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001774:Blood Chemical Analysis; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy*; D054038:Posterior Leukoencephalopathy Syndrome / Q000201:enzymology* / Q000209:etiology* / Q000473:pathology; D012189:Retrospective Studies; D013997:Time Factors
D000970:Antineoplastic Agents; D007770:L-Lactate Dehydrogenase
Chemotherapy; Hypertensive encephalopathy; LDH; PRES; Posterior reversible encephalopathy syndrome