Clin Chem Lab Med 2006;44(4):460–463  2006 by Walter de Gruyter • Berlin • New York. DOI 10.1515/CCLM.2006.068 2006/376 Article in press - uncorrected proof Time-level relationship between indicators of oxidative stress and Glasgow Coma Scale scores of severe head injury patients Chandrika Nayak 1, *, Dinesh Nayak 2 , Annaswamy Raja 3 and Anjali Rao 4 1 Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus), Manipal, India 2 Department of Pediatrics, 3 Department of Neurosurgery, Kasturba Medical College and Hospital, Manipal, India 4 Department of Biochemistry, Kasturba Medical College, Manipal, India Abstract Background: Oxidative stress is said to strongly influ- ence the neurological recovery of patients following a severe head injury. Estimation of the markers of oxi- dative stress in the blood of such patients can hence aid in predicting the prognosis of head injury. Methods: Erythrocyte thiobarbituric acid-reactive substances (TBARS) and plasma ceruloplasmin (CP) levels were estimated in 24 severe head-injury patients on days 1, 7 and 21 of the post-traumatic period and compared with levels in 25 healthy age- and sex-matched controls. These parameters reflect- ing oxidative stress status were related to the Glasgow Coma Scale (GCS) scores of patients noted at the same time points of the study period. Results: Lipid peroxidation as indicated by increased levels of erythrocyte TBARS remained significantly elevated in severe head injury patients compared to controls on day 1 (p-0.001), day 7 (p-0.001) and 21 (p-0.001) of the post-traumatic period. Plasma CP levels remained significantly elevated (p-0.001) at these three time points compared to controls. The sig- nificant decrease in lipid peroxidation products (p-0.01) and significant increase in CP levels (p-0.001) on day 21 compared to day 1 in head injury patients correlated well with the significant improve- ment in GCS scores of patients on day 21 compared to day 1 (p-0.05). Conclusion: The above results could account for the adaptation of the study patients to severe oxidative stress, as evidenced by their clinical recovery trend during the study period. Keywords: ceruloplasmin; Glasgow Coma Scale; head injury; lipid peroxidation. *Corresponding author: Dr. Chandrika Nayak, Assistant Professor, Department of Biochemistry, Melaka Manipal Medical College (Manipal Campus), International Center for Health Sciences, Manipal 576 104, Karnataka, India Phone: q91-820-2571201x22570, Fax: q91-820-2571905, E-mail: chandrikadinesh@yahoo.com Introduction A sudden devastating injury to the human brain can represent a threat to life or the quality of life. Experi- mental evidence supporting the role of free radicals in secondary processes after a traumatic head injury is overwhelming (1–6). Free radicals containing oxy- gen or nitrogen and generated by endogenous met- abolic pathways are found to be lethal when generated in excess (7). To combat these potential toxins, called oxidants, living organisms have been endowed with a rich defensive system involving antioxidants. Oxidative stress is a metabolic state defined as ‘‘an imbalance between oxidants and antioxidants in favor of the oxidants, potentially leading to damage of bio- logical molecules’’ (8). The brain consumes 20% of the total oxygen inspired by the body, and its inherent biochemical, anatomical and physiological character- istics make it vulnerable to oxidative insult (9, 10). Lipid peroxidation, the damage of lipids induced by excess production of reactive oxygen species (ROS), is said to play a crucial role in post-traumatic neuronal degeneration following a traumatic head injury in humans (11). Plasma ceruloplasmin (CP) levels have also been reported to be elevated in severe head inju- ry (SHI) patients in the post-traumatic period (12). The Glasgow Coma Scale (GCS) is the most com- mon grading scale in neurotraumatology and is used to quantify the clinical severity of brain trauma. Its validity in providing strong predictive value in assess- ing the functional outcome for traumatic head injury patients is well accepted in the Anglo-American lit- erature (13). Very few data are available regarding the relationship between the time course of biochemical and clinical parameters in the post-traumatic period of head injury in humans. This study attempted to evaluate the time course of indicators of oxidative stress in blood of SHI patients and to relate it to changes in the GCS score, with the hope that results would give valuable data for designing new therapeu- tic strategies and clinical advice to modulate free radi- cal toxicity-induced brain damage in SHI patients. Materials and methods A total of 24 SHI patients (all males) aged between 24 and 65 years (mean 29.0"8.7 years) with a post-resuscitation GCS score of 8 or less (mean 5.21"1.5) were included in this clinical study. Healthy age- and sex-matched individuals (ns25) were considered as controls for this comparative study. SHI patients enrolled into the study and who died in the hospital during the study period were excluded. Patients Brought to you by | Purdue University Libraries Authenticated Download Date | 5/27/15 6:51 PM