The Prognostic Value of Brain Extracellular Fluid Nitric Oxide Metabolites After Traumatic Brain Injury

被引:20
作者
Tisdall, Martin M. [1 ,2 ,3 ]
Rejdak, Konrad [4 ]
Kitchen, Neil D. [3 ]
Smith, Martin [1 ,2 ]
Petzold, Axel [1 ,2 ,5 ]
机构
[1] Natl Hosp Neurol & Neurosurg, Dept Neuroanaesthesia, London WC1N 3BG, England
[2] Natl Hosp Neurol & Neurosurg, Dept Neurocrit Care, London WC1N 3BG, England
[3] Natl Hosp Neurol & Neurosurg, Victor Horsley Dept Neurosurg, London WC1N 3BG, England
[4] Med Univ Lublin, Dept Neurol, Lublin, Poland
[5] Vrije Univ Amsterdam, Med Ctr, Dept Neurol, Amsterdam, Netherlands
关键词
Traumatic brain injury; Microdialysis; Nitric oxide; Neurocritical care; Neuromonitoring; SEVERE HEAD-INJURY; CEREBROSPINAL-FLUID; MICRODIALYSIS; NITRATE;
D O I
10.1007/s12028-011-9633-5
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Nitric oxide (NO) is a compound with both protective and damaging effects on neurons. Quantification of NO metabolites in humans is limited by sample contamination with blood. In vivo cerebral microdialysis may offer an alternative approach as sampling of extracellular fluid (ECF) adjacent to neurons becomes possible. We investigate the prognostic value of brain ECF NO metabolites in patients with traumatic brain injury (TBI). A prospective case cohort of 195 ECF samples collected from 11 cases over 4 days following TBI was collected. Nitrate and nitrite concentrations ([NO (x) ]) were quantified using a vanadium-based colorimetric assay. Early ECF [NO (x) ] (< 48 h post TBI) were significantly higher in non-survivors (median 59.2 mu mol/l, n = 7) compared to survivors (23.3 mu mol/l, n = 4) (P = 0.04). Late (48-96 h) ECF [NO (x) ] remained higher in non-survivors (47.9 mu mol/l) compared to survivors (23.0 mu mol/l) but this was not significant (P = 0.29). Receiver operator characteristic analysis shows an optimized cutoff level for ECF [NO (x) ] of 26.5 mu mol/l measured < 48 h post TBI for predicting non-survival (sensitivity 100%, specificity 75%). Early ECF NO (x) concentrations are of prognostic value after TBI. ECF NO (x) may be a useful biomarker for treatment trials targeted at nitric oxide metabolism.
引用
收藏
页码:65 / 68
页数:4
相关论文
共 11 条
[1]   Consensus meeting on microdialysis in neurointensive care [J].
Bellander, BM ;
Cantais, E ;
Enblad, P ;
Hutchinson, P ;
Nordström, CH ;
Robertson, C ;
Sahuquillo, J ;
Smith, M ;
Stocchetti, N ;
Ungerstedt, U ;
Unterberg, A ;
Olsen, NV .
INTENSIVE CARE MEDICINE, 2004, 30 (12) :2166-2169
[2]   Nitric oxide in traumatic brain injury [J].
Cherian, L ;
Hlatky, R ;
Robertson, CS .
BRAIN PATHOLOGY, 2004, 14 (02) :195-201
[3]   Cerebrospinal fluid and plasma nitrite and nitrate concentrations after head injury in humans [J].
Clark, RSB ;
Kochanek, PM ;
Obrist, WD ;
Wong, HR ;
Billiar, TR ;
Wisniewski, SR ;
Marion, DW .
CRITICAL CARE MEDICINE, 1996, 24 (07) :1243-1251
[4]   Role of nitric oxide in cerebral blood flow abnormalities after traumatic brain injury [J].
Hlatky, R ;
Goodman, JC ;
Valadka, AB ;
Robertson, CS .
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 2003, 23 (05) :582-588
[5]  
Hlatky R, 2002, ACTA NEUROCHIR SUPPL, V81, P331
[6]   A rapid, simple spectrophotometric method for simultaneous detection of nitrate and nitrite [J].
Miranda, KM ;
Espey, MG ;
Wink, DA .
NITRIC OXIDE-BIOLOGY AND CHEMISTRY, 2001, 5 (01) :62-71
[7]   Nitric oxide, cell bioenergetics and neurodegeneration [J].
Moncada, Salvador ;
Bolanos, Juan P. .
JOURNAL OF NEUROCHEMISTRY, 2006, 97 (06) :1676-1689
[8]   In vivo monitoring of neuronal loss in traumatic brain injury: a microdialysis study [J].
Petzold, Axel ;
Tisdall, Martin M. ;
Girbes, Armand R. ;
Martinian, Lillian ;
Thom, Maria ;
Kitchen, Neil ;
Smith, Martin .
BRAIN, 2011, 134 :464-483
[9]   Cerebrospinal fluid nitrite/nitrate correlated with oxyhemoglobin and outcome in patients with subarachnoid hemorrhage [J].
Rejdak, K ;
Petzold, A ;
Sharpe, MA ;
Kay, AD ;
Kerr, M ;
Keir, G ;
Thompson, EJ ;
Giovannoni, G .
JOURNAL OF THE NEUROLOGICAL SCIENCES, 2004, 219 (1-2) :71-76
[10]   Cerebral microdialysis: research technique or clinical tool [J].
Tisdall, M. M. ;
Smith, M. .
BRITISH JOURNAL OF ANAESTHESIA, 2006, 97 (01) :18-25