Systemic Oxidative Stress in Subacute Stroke Patients Undergoing Rehabilitation Treatment

Abstract

The imbalance in oxidative stress in acute stroke has been extensively studied; on the contrary, its investigation in the subacute phase is limited. The aim of this study was to analyse the variation in the systemic oxidative status in subacute post-stroke patients before (T0) and after a six-week rehabilitation treatment (T1) and to investigate the relationship between systemic oxidative status and rehabilitation outcomes. We enrolled 109 subjects in two different centres, and we analysed their serum hydroperoxide levels (d-ROMs), biological antioxidant power (BAP), thiol antioxidant components (-SHp), and relative antioxidant capacity (OSI and SH-OSI indices). Activity of Daily Living (ADL), hand grip strength, and walking endurance were evaluated using the modified Barthel Index, the Hand Grip test, and the 6-min walk test, respectively. At T0, most of the patients showed very high levels of d-ROMs and suboptimal levels of the BAP, OSI, and SH-OSI indices. Comparing the T1 and T0 data, we observed an improvement in the rehabilitation outcomes and a significant decrease in d-ROMs (549 ± 126 vs. 523 ± 148, p = 0.023), as well as an improvement in the OSI and SH-OSI indices (4.3 ± 1.3 vs. 4.7 ± 1.5, p = 0.001; 11.0 ± 0.4 vs. 1.2 ± 0.4, p < 0.001). In addition, significant correlations were seen between the oxidative stress parameters and the rehabilitation outcomes. These results suggest monitoring the systemic oxidative stress status in post-stroke patients in order to plan a tailored intervention, considering its relationship with functional recovery.

Keywords: antioxidant defences; hydroperoxides; oxidative stress; post stroke; rehabilitation; thiols.

Figure 1

The histograms show at baseline (T0) the percentage of patients for each reference range of d-ROMs, BAP, and the -SHp. The reference ranges for the d-ROMs are as follows: normal (250–300 UCARR), borderline (301–320 UCARR), low level (321–340 UCARR), middle level (341–400 UCARR), high level (401–500 UCARR), and very high level (>500 UCARR). The reference ranges for the BAP are as follows: optimal status (>2200 µmol/L), borderline status (2200–2000 µmol/L), slight deficiency status (1999–1800 µmol/L), deficiency status (1799–1600 µmol/L), and high deficiency status (<1600 µmol/L). The reference range for the -SHp are as follows: normal levels (>450 µmol/L), insufficient levels (<450 µmol/L). The dashed area refers to the range of normality.

Figure 2

Changes in oxidative stress parameters between baseline (T0) and at the end of the rehabilitation program (T1). Mean bars and 95% CI are reported. The p-value refers to the statistically significant differences found by the Wilcoxon signed-rank test.