Research Reports - Cerebrospinal fluid nitric oxide metabolite levels as a biomarker in severe traumatic brain injury

Int J Neurosci. 2012 Dec 27

Kandasamy R, Pal HK, Swamy M

Abstract Nitric Oxide has a definitive role in the complex pathophysiology of
Traumatc Brain Injury (TBI). This prospective cohort study investigated the
changes in Nitric Oxide Metabolite (NOx) levels in cerebrospinal fluid (CSF) and
their correlation with factors associated with severity and prognosis following
severe TBI. NOx levels were measured in CSF obtained via ventriculostomy in 44
adult patients admitted after severe TBI (Glasgow Coma Scale (GCS) ≤ 8/15). The
overall mean level of CSF NOx in the study population was 7.40 ±1.59μmol/L.
Levels of CSF NOx were found to be significantly higher in subgroups of patients
with poorer outcome measured by Glasgow Outcome Scale (GOS) score (p<0.042), in
patients with high Intra Cranial Pressure (ICP) readings (p< 0.027) and in those
with higher Marshall Computed Tomography (CT) grading scores (p< 0.026). Simple
logistic regression demonstrated that CSF NOx levels were a significant predictor
of ICP (b = 0.493, 95% CI: 1.03, 2.58, p = 0.033). A patient with 1μmol/L
increase in NOx level had 1.6 times the odds to have an ICP ≥ 20mmHg when other
confounders were not adjusted. NOx level is also a significant predictor of
Marshall CT Grading (b = 0.473, 95% CI: 1.02, 2.50, p = 0.037). A patient with
1μmol/L increase in NOx level had 1.6 times the odds to have a high Marshall
Grade when other confounders were not adjusted. It can be concluded that CSF NOx
levels may serve as a potentially useful biomarker in severe TBI given its
significant association with ICP readings as well as Marshall CT grading.

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