ADMA Levels and Arginine/ADMA Ratios Reflect Severity of Disease and Extent of Inflammation After Subarachnoid Hemorrhage

作者：Lindgren Cecilia^*; Hultin Magnus; Koskinen Lars Owe D; Lindvall Peter; Borota Ljubisa; Naredi Silvana

来源：Neurocritical Care, 2014, 21(1): 91-101.

DOI：10.1007/s12028-013-9945-8

• Subarachnoid hemorrhage
• ADMA
• Arginine
• Inflammation
• Interleukin-1beta
• Interleukin-6
• Interleukin-8
• Interleukin-10
• Tumor necrosis factor-alpha

Subarachnoid hemorrhage (SAH) is characterized by an inflammatory response that might induce endothelial dysfunction. The aim of this study was to evaluate if ADMA and arginine/ADMA ratios after SAH (indicators of endothelial dysfunction) are related to clinical parameters, inflammatory response, and outcome. %26lt;br%26gt;Prospective observational study. ADMA, arginine, C-reactive protein (CRP), and cytokines were obtained 0-240 h (h) after SAH. Definition of severe clinical condition was Hunt%26Hess (H%26H) 3-5 and less severe clinical condition H%26H 1-2. Impaired cerebral circulation was assessed by clinical examination, transcranial doppler, CT-scan, and angiography. Glasgow outcome scale (GOS) evaluated the outcome. %26lt;br%26gt;Compared to admission, 0-48 h after SAH, the following was observed 49-240 h after SAH; (a) ADMA was significantly increased at 97-240 h (highest 217-240 h), (b) CRP was significantly increased at 49-240 h (highest 73-96 h), (c) interleukin-6 (IL-6) was significantly lower at 97-240 h (highest 49-96 h), p %26lt; 0.05. ADMA, CRP, and IL-6 were significantly lower and peak arginine/ADMA ratio was significantly higher in patients with H%26H 1-2 compared to patients with H%26H 3-5, p %26lt; 0.05. The peak ADMA or the nadir arginine/ADMA ratio did not differ significantly between patients with (55 %) or without (45 %) signs of impaired cerebral circulation. The peak ADMA or the nadir arginine/ADMA ratio did not differ significantly between patients with GOS 1-3 and patients with GOS 4-5. %26lt;br%26gt;ADMA increased significantly after SAH, and the increase in ADMA started after the pro-inflammatory markers (CRP and IL-6) had peaked. This might indicate that endothelial dysfunction, with ADMA as a marker, is induced by a systemic inflammation.

• 出版日期2014-8