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

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Abstract

Background

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).

Methods

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.

Results

Early ECF [NO x ] (<48 h post TBI) were significantly higher in non-survivors (median 59.2 μmol/l, n = 7) compared to survivors (23.3 μmol/l, n = 4) (P = 0.04). Late (48–96 h) ECF [NO x ] remained higher in non-survivors (47.9 μmol/l) compared to survivors (23.0 μmol/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 μmol/l measured <48 h post TBI for predicting non-survival (sensitivity 100%, specificity 75%).

Conclusion

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.

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Acknowledgment

MT is supported by a Wellcome Clinical Research Training Fellowship Grant, Grant No 075608. MS is partially funded by the Department of Health’s National Institute for Health Research Centres funding scheme via the UCLH/UCL Comprehensive Biomedical Research Centre.

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Authors and Affiliations

  1. Departments of Neuroanaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Martin M. Tisdall, Martin Smith & Axel Petzold

  2. Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK

    Martin M. Tisdall & Neil D. Kitchen

  3. Department of Neurology, Medical University of Lublin, Lublin, Poland

    Konrad Rejdak

  4. Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands

    Axel Petzold

Authors
  1. Martin M. Tisdall
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  2. Konrad Rejdak
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  3. Neil D. Kitchen
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  4. Martin Smith
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  5. Axel Petzold
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Correspondence to Martin M. Tisdall.

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Tisdall, M.M., Rejdak, K., Kitchen, N.D. et al. The Prognostic Value of Brain Extracellular Fluid Nitric Oxide Metabolites After Traumatic Brain Injury. Neurocrit Care 19, 65–68 (2013). https://doi.org/10.1007/s12028-011-9633-5

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  • DOI: https://doi.org/10.1007/s12028-011-9633-5

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