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The Relation between Glasgow Coma Score and Blood Superoxide Dismutase Activity in Patients with Traumatic Brain Injury


A. Bayır1* and A. Kıyıcı 2
1. Selçuklu Faculty of Medicine, Emergency Department, SelcukUniversity, Konya, Turkey, 9042065

2. Selcuklu Faculty of Medicine, Biochemistry Department, SelçukUniversity, Konya, Turkey, 9042065
* Corresponding Author: Emergency Department, Selcuk University, email: aysegulbayir@hotmail.com 


ABSTRACT

Aim: Reactive oxygen species are playing a primary role in traumatic brain injury. The aim of this study was to investigate the relationship between blood Superoxide dismutase (SOD) levels and Glasgow Coma Score (GCS) in patients with head trauma on admission to emergency department (ED).

Methods: The subjects of this study were patients with a head injury. For each one of them, a GCS was calculated upon admission to the ED and SOD activity in the blood was also examined.  The data was compared using a Mann-Whitney U test and a chi square test. A p≤0.05 level was considered to be significant. Results: It was determined a significant relationship between the SOD activity and GCS (p=0.012). There was a positive correlation between SOD levels and GCS (r=0,250).  Conclusion: Low SOD levels could be an indicator for severe brain injury in head trauma.

Keywords: Brain injury, head trauma, Glasgow Coma Score, Superoxide Dismutase

INTRODUCTION

The brain damage from a head injury occurs primarily at impact and secondarily with the onset of autodestructive processes. Early oxidative changes in the plasma, erythrocytes and cerebral spinal fluid (CSF) have shown a significant correlation with neurological outcomes that occur in a traumatic brain injury (TBI). The aim of this present study was to investigate the relationship between Superoxide Dismutase (SOD) levels and the Glasgow Coma Score (GCS) for patients with head trauma who were admitted to an emergency department (ED).

METHODS

This study was made in Emergency Department of Selçuk University Faculty of Medicine. Ethical Board consent was obtained from Faculty Ethical Board for study. The patients with acute head trauma were included to the study. GCS scores was determined each patients on admission to the Emergency Department. Patients were divided into 2 group according to GCS scores (GCS score low than 9 and GCS score 9 or higher). Venous blood samples were collected in EDTA vacutainers. SOD activity in the blood was also examined with SOD Assay Kit (Sigma). The data was compared using a Mann-Whitney U test and a chi square test.  A p≤0.05 level was considered to be significant.

RESULTS

The study included a total of 115 patients. The mean age of the patients was 36.1±27.5. Thirty two of the patients were female (mean age 25.3±9.6), and 83 were male (mean age 34.5±15.2). Eighty three patients had an isolated head trauma and twenty seven had multiple system trauma (seven with 2 system injuries and 20 with 3, or more, system injuries).  The mean GCS of the patients was 5.7±4.3 (min. 3-max. 13) and the mean SOD activity was 2914 (min. 1032-max. 5786) Ug/Hb. There was a significant relationship between the SOD activity and GCS (p=0.012). There was also a significant correlation between the two. The mean SOD levels were 2122 Ug/Hb in the 64 patients with GCS<8 and the mean SOD levels were 3679 Ug/Hb in 51 patients with GCS≥9. There was a significant difference between the patients with GCS<8 and in patients with GCS≥9 at the point of p=0.021 SOD activity.

DISCUSSION

Reactive oxygen species-mediated oxidative damage can play an important role in determining the prognosis of severe brain injury (Paolin et al, 2002). Previous studies demonstrated that Oxidative stress is an intrinsic component of the neurological sequel of traumatic head injury (Wu A et al, 2006). It has been detected significant relationship between SOD activities and GSC scores in head trauma patients. 

In a study stated that erythrocyte SOD activities did negative correlated with GCS (Nayak CD et al, 2007).

In our study, it was determined a relationship between SOD activities and GCS scores in head trauma patients. Additionaly, mean blood SOD activities was found lower in patients with GCS scores below 9 than in patients with GCS scores 9 or higher. Lower SOD levels in patients with head trauma could be an indicator of poor prognosis and severe brain injury.

ACKNOWLEDGEMENT

There are not.

CITATIONS AND REFERENCE LIST

1. Nayak CD, Nayak DM, Raja A, Rao A. Erythrocyte indicators of oxidative changes in patients with graded traumatic head injury. Neurol India. 2008;56(1):31-5.
2. Nayak CD, Nayak DM, Raja A, Rao A. Time-relative changes in the erythrocyte antioxidant enzyme activities and their relationship with Glasgow Coma Scale scores in severe head injury patients in the 21-day posttraumatic study period. Indian J Med Sci. 2007;61(7):381-9.
3. Paolin A, Lorella N, Gaetani P, Riccardo RY, Orietta P, Fulvio M. Oxidative damage after severe head injury and its relationship to neurological outcome. Neurosurgery 2002;51:949-54.
4.  Nayak C, Nayak D, Raja A, Rao A. Time-level relationship between indicators of oxidative stress and Glasgow Coma Scale scores of severe head injury patients. Clin Chem Lab Med 2006;44:460-3. 
5.  Kasprzak HA, Wozniak A, Drewa G, Wozniak B. Enhanced lipid peroxidation processes in patients after brain contusion. J Neurotrauma 2001;18:793-7. 
6.  Tyurin VA, Tyurina YY, Borisenko GG, Sokolova TV, Ritov VB, Quinn PJ, et al. Oxidative stress following traumatic brain injury in rats: Quantitation of biomarkers and detection of free radical intermediates. J Neurochem 2000;75:2178-89.