Serum malondialdehyde levels in patients with malignant middle cerebral artery infarction are associated with mortality.
OBJECTIVE
Malondialdehyde (MDA) is an end-product formed during lipid peroxidation, due to degradation of cellular membrane phospholipids. MDA is released into extracellular space and finally into the blood; it has been used as an effective biomarker of lipid oxidation. High circulating levels of MDA have been previously described in patients with ischemic stoke than in controls, and an association between circulating MDA levels and neurological functional outcome in patients with ischemic stoke. However, an association between serum MDA levels and mortality in patients with ischemic stroke has not been previously reported, and that was the objective of this study.


METHODS
Observational, prospective and multicenter study performed in six Intensive Care Units. We included patients with severe malignant middle cerebral artery infarction (MMCAI) defined as Glasgow Coma Scale (GCS) lower than 9. We measured serum MDA levels in 50 patients with severe MMCAI at the time of diagnosis and in 100 healthy subjects. Mortality at 30 days was the end point of the study.


RESULTS
We found that patients with severe MMCAI showed higher serum MDA levels than healthy subjects (p<0.001). We found higher serum MDA levels (p<0.001) in non-surviving MMCAI patients (n=26) than in survivors (n=24). The area under the curve for prediction of 30-day mortality for serum MDA levels was 0.77 (95% CI = 0.63-0.88; p<0.001). Serum MDA levels >2.27 nmol/mL were associated with 30-day mortality (OR=7.23; 95% CI=1.84-28.73; p=0.005) controlling for GCS and age on multiple binomial logistic regression analysis.


CONCLUSIONS
To our knowledge, this is the first study showing that serum malondialdehyde levels in patients with MMCAI are associated with early mortality.
Intensive Care Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Leonardo
L
Lorente
Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
María M
MM
Martín
Deparment of Phisiology, Faculty of Medicine, University of the La Laguna, La Laguna. Santa Cruz de Tenerife, Spain.
Pedro
P
Abreu-González
Intensive Care Unit, Hospital General La Palma, Breña Alta, La Palma, Spain.
Luis
L
Ramos
Intensive Care Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Mónica
M
Argueso
Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Las Palmas de Gran Canaria, Spain.
Jordi
J
Solé-Violán
Servicio de Bioquímica Clínica, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain.
Marta
M
Riaño-Ruiz
Research Unit, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
Alejandro
A
Jiménez
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D005260:Female; D015600:Glasgow Coma Scale; D006338:Heart Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000097:blood* / Q000401:mortality / Q000473:pathology; D007362:Intensive Care Units; D015227:Lipid Peroxidation; D008297:Male; D008315:Malondialdehyde / Q000097:blood*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D020521:Stroke / Q000097:blood* / Q000401:mortality / Q000473:pathology; D017741:Survivors
D015415:Biomarkers; D008315:Malondialdehyde