The Role of Serial Oxidative Stress Levels in Acute Traumatic Brain Injury and as Predictors of Outcome.
BACKGROUND
Oxidative stress is thought to participate in the pathobiology of secondary brain injury after acute traumatic brain injury (TBI). This study posits that oxidative stress levels in acute TBI are predictive of outcome.


METHODS
Two hundred and twenty-nine blood samples from 88 patients admitted within 24 hours after TBI were obtained on admission and on days 4 and 7. Serial plasma oxidative level and antioxidant were examined in 88 patients with acute TBI and 27 control individuals.


RESULTS
Compared with controls, patients with TBI had significantly increased serum glutathione (GSH) levels on presentation and significantly decreased erythrocyte superoxide dismutase levels. Outcome was assessed on discharge using the Glasgow Outcome Scale. Serum GSH and erythrocyte superoxide dismutase levels were significantly higher in the good outcome group than in the poor outcome group on day 1 (P = 0.008 and P = 0.026, respectively). In the logistic regression analysis, only motor deficits and GSH levels on presentation were independently associated with outcome. A GSH cutoff value of 1.106 μmol/L on presentation was associated with good outcome in patients with acute TBI.


CONCLUSIONS
Quantifying biomarkers of oxidative stress and antioxidant status of serum correlate with trauma severity and may be used to predict outcomes after TBI. Higher serum GSH levels on admission are associated with better outcome.
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Hung-Chen
HC
Wang
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan.
Yu-Jun
YJ
Lin
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Fu-Yuan
FY
Shih
Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Hsueh-Wen
HW
Chang
Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Yu-Jih
YJ
Su
Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ben-Chung
BC
Cheng
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Chih-Min
CM
Su
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Nai-Wen
NW
Tsai
Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ya-Ting
YT
Chang
Department of Neurosurgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Aij-Lie
AL
Kwan
Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, Taiwan. Electronic address: chlu99@ms44.url.com.tw.
Cheng-Hsien
CH
Lu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000378:metabolism; D001930:Brain Injuries / Q000378:metabolism / Q000628:therapy; D004247:DNA / Q000097:blood; D004912:Erythrocytes / Q000201:enzymology; D005260:Female; D023261:Glasgow Outcome Scale; D005978:Glutathione / Q000097:blood; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013482:Superoxide Dismutase / Q000097:blood; D017392:Thiobarbituric Acid Reactive Substances / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult
D000975:Antioxidants; D017392:Thiobarbituric Acid Reactive Substances; D004247:DNA; D013482:Superoxide Dismutase; D005978:Glutathione
Glutathione; Outcome; Oxidative stress; Traumatic brain injury