Improved accuracy of delayed cerebral ischemia diagnosis with plasma nitric oxide synthase 3, nicotinamide adenine dinucleotide phosphate, and 8-iso-prostaglandin F2α

OBJECTIVE The pathophysiology of delayed cerebral ischemia (DCI) is not fully elucidated. The lack of accurate diagnostic tools increases the probability of delayed diagnosis and timely treatment. The authors assessed the relationship of 8-iso-prostaglandin F 2α (F2-IsoP) and oxidative stress biomarkers, nitric oxide synthase 3 (NOS3) and nicotinamide adenine dinucleotide phosphate (NADPH), with DCI after aneurysmal subarachnoid hemorrhage (aSAH). METHODS The authors assessed 65 aSAH patients for F2-IsoP, NOS3, and NADPH concentrations using commercial ELISA on days 2, 4, and 6 after aSAH. The authors examined the correlations of plasma F2-IsoP, NOS3, and NADPH concentrations and clinical variables with DCI onset. RESULTS F2-IsoP, NOS3, and NADPH are important laboratory predictors of DCI. Of the clinical predictors, modified Fisher grade, Hunt and Hess grade, and tobacco smoking were the most significant predictors. In patients with DCI, plasma F2-IsoP and NOS3 concentrations were higher, and NADPH concentrations were lower, than in those without DCI (p < 0.01). Plasma F2-IsoP concentration on day 2, and NADPH and NOS3 concentrations on day 6, correlated with DCI occurrence (p < 0.01). CONCLUSIONS The authors observed decreased antioxidant capacity in patients with DCI, which may be explained by increased F2-IsoP and decreased NADPH. Assessment of F2-IsoP, NOS3, and NADPH may improve the diagnostic accuracy of DCI. Further work is required to determine the role of F2-IsoP, NOS3, and NADPH in clinical practice and DCI pathophysiology.