Assessment of redox balance parameters among patients with acute ischaemic stroke

Abstract

Clinical rationale for study: Oxidative stress (OS) is believed to play a crucial role in the development of neuronal injury associated with ischaemic stroke (IS). The evaluation of redox homeostasis in patients with acute ischaemic stroke (AIS) and its relation to stroke subtypes and short-term outcomes has scarcely been studied, and the findings are unclear.

Aim of study: This study evaluates OS and antioxidant status in patients with AIS in the Podlaskie Voivodeship in Poland within 2-5 days of stroke onset, compared to healthy controls.

Material and methods: The study involved 187 patients with AIS, with 85 receiving intravenous thrombolysis and/or mechanical thrombectomy, and included 94 healthy controls as a comparison group. The research measured serum total oxidant status (TOS) and total antioxidant status (TAS) using Erel's method-based kits, and calculated the oxidative stress index (OSI).

Results: Significant differences were found in TOS levels between patients with AIS and healthy controls (p = 0.049). Serum TAS concentrations were significantly higher in patients with AIS due to large artery atherosclerosis (LAA) than in those with cardioembolism (CE) or small vessel occlusion (SVO) aetiology, as classified by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria (p = 0.043). Receiver Operating Characteristic (ROC) curve analysis established cut-off values as potential indicators of OS in patients with AIS: TAS < 1.34 mmol/L, TOS > 5.6 μmol H2O2 equiv./L, and OSI > 3.96.

Conclusions and clinical implications: Our findings demonstrate that an imbalance of oxidant and antioxidant status might play a role in the pathogenesis of IS. Patients in the initial phase of IS showed increased TOS, but no change in TAS, compared to healthy controls. This suggests effective initial antioxidant defence. TOS levels exhibited potential utility as clinical diagnostic biomarkers in patients with AIS. Although an imbalance towards oxidants may play a role in the pathogenesis of IS, these markers alone do not adequately predict stroke severity. Therefore, an analysis of the oxidant and antioxidant balance could play a crucial role in clarifying the pathogenic pathways of IS, presenting valuable diagnostic and prognostic tools, and identifying novel targets for antioxidant-focused therapies with neuroprotective agents.

Keywords: ischaemic stroke; neuroprotective agents; oxidative stress; oxidative stress index; redox balance parameters; total antioxidant status; total oxidant status.