We investigated the association of fetal serum thiol/disulfide homeostasis and ischemia-modified albumin (IMA) levels with fetal distress (FD). Methods: Umbilical cord blood for native thiol, total thiol, disulfide, albumin, and IMA analysis was obtained from 44 pregnant women over 34 weeks gestation undergoing cesarean section due to non-acute FD, and from 61 healthy pregnant women who underwent elective cesarean section Results: Native thiol and total thiol levels were significantly lower in the FD group (p = 0.02 and p = 0.014, respectively). Although disulfide/native thiol and disulfide/total thiol ratios were higher in the FD group, the difference was statistically insignificant (p = 0.805). The IMA levels were significantly higher in the FD group (p = 0.013). Conclusion: The thiol-disulfide homeostasis shifts toward the oxidant direction during the FD pathogenesis and the increased IMA levels may be the best indicator of an underlying non-acute ischemic condition.

Keywords: fetal distress; ischemia-modified albumin; pregnancy outcomes; thiol/disulfide homeostasis.

Purpose: It was aimed to assess the role of thiol-disulphide homeostasis and ischemia-modified albumin (IMA) level in the development of diabetic macular edema (DME) in patients with diabetes mellitus type 2 (T2DM).

Materials and methods: Sixty-six study patients were divided into two groups. Group I included 43 patients with T2DM and DME, and Group 2 included 23 patients with T2DM without eye involvement. A novel colorimetric method was used to assess thiol-disulphide homeostasis. Between the two groups IMA, total anti-oxidant, and total oxidant levels were measured and compared.

Results: In Group 1, total and native thiols levels and disulphide levels were lower compared to Group 2 (p = 0.025, p<0.001 and p = 0.013, respectively). Disulphide/native thiol, disulphide/total thiol ratios and native thiol/total thiol were similar between the groups. Total anti-oxidant level (TAL) reduced whereas total oxidant level (TOL) increased in Group 1 compared to Group 2 (p=0.001, p=0.002, respectively). Albumin level decreased, whereas IMA level increased in Group 1 compared to Group 2, (p<0.001 for both).

Conclusions: The disruption in thiol/disulphide homeostasis, increased IMA and oxidative stress have an impact on the development of diabetic macular edema.

Keywords: Albumin; Diabetic eye disease; Disulphide; Reactive oxygen species; Thiols.

Obstructive sleep apnea (OSA) is associated with an increased risk of atherosclerosis. Carotid intima-media thickness (CIMT) is strongly associated with the presence of significant risk factors for cardiovascular disturbances. A disturbance in the oxidative/antioxidative balance is involved in the pathogenesis of OSA and cardiovascular diseases. Ischemia-modified albumin (IMA) is suggested as a novel marker of oxidative stress; IMA can be defined as decreased binding of transitional metal ions to serum albumin in oxidative status. The purpose of this research was to evaluate the influence of OSA on IMA levels and CIMT. In total, 61 individuals with OSA with no comorbidities and 24 healthy controls with a similar body mass index and age were enrolled in this study. Serum levels of IMA, CIMT (estimated radiologically), and polysomnographic parameters, were determined and interpreted. Serum IMA levels were significantly higher in individuals with OSA compared with the control group (p=0.0003). CIMT was significantly higher in the OSA group compared with the control group (0.88± 0.26 mm vs 0.75±0.17 mm, p=0.005). The CIMT and serum IMA levels were positively correlated with the apnea-hypopnea index (r=0.35 and r=0.32, respectively), and with the oxygen desaturation index (r=0.34 and r=0.29, respectively) at baseline. Increased IMA levels and CIMT may be related to increased oxidative stress and risk of atherosclerosis in individuals with OSA.

Genetic, neurobiological, neurochemical, environmental factors and their interactions contribute to autism phenotypes. Blood from 48 (age range: 4-17) autism spectrum disorder diagnosed patients (ASD) and 38 age- and gender-matched healthy control subjects was analyzed for numbers of neutrophils, lymphocytes, monocytes, albumin, serum Ischemia-Modified Albumin (IMA) levels and myeloperoxidase activity. The serum IMA levels, myeloperoxidase activity and peripheral blood mononuclear cells count were significantly higher in ASD cases than in the control subjects. There were no significant differences in albumin levels between the patient and control groups. These results suggest that the immune system, oxidative stress and myeloperoxidase activity may be activated in ASD. There is a clinical benefit from the early detection of ASD using myeloperoxidase activity, IMA levels and monocyte counts.

Keywords: ASD; Autism spectrum disorder; IMA; Ischemia-modified albumin; Lymphocytes; Monocytes; Myeloperoxidase; Neutrophils.

This study aims to examine the role of ischaemic-modified albumin (IMA) in predicting clomiphene citrate (CC) resistance in patients with CC-resistant and CC-sensitive infertile polycystic ovary syndrome (PCOS). Sixty women patients admitted to the infertility clinic were evaluated. The patients were divided into two groups. Group 1 comprised 30 infertile PCOS patients with CC resistance; group 2 was the control group comprising 30 infertile PCOS patients with CC sensitivity. Serum IMA levels of PCOS patients with CC resistance were significantly higher than CC sensitivity patients (p < .001). The independent variables BMI and age effects were adjusted according to the logistic regression method with groups. Significant differences were observed between the two groups in the levels of IMA (p = .0005), HOMA-IR (p = .0045), insulin (p = .022), free testosterone (p = .0001) and total testosterone (p = .03) values. By using ROC curve analysis for IMA between study and control groups, cut off point of IMA was calculated as 0.505 U/mL, sensitivity was 80% and specificity was 63%. The area under the curve was 0.926. This shows us that more oxidative stress (OS) occurs in the CC-resistant group. As a reflection of OS in the follicular endocrine, microenvironment may be linked with impaired oocyte developmental competence and embryo quality in association with increased IMA, free testosterone, total testosterone, insulin and HOMA-IR levels. Impact statement What is already known on this subject? In previous studies, IMA was compared between PCOS and control groups. In this study, serum IMA levels were measured in infertile PCOS patients resistant to CC for the first time. What the results of this study add? Serum IMA levels were significantly higher in resistant infertile PCOS patients compared to the control group. This shows us that more OS occurs in the CC-resistant group. What the implications are of these findings for clinical practice and/or further research? IMA will be a guide for PCOS management in patients with CC-resistant PCOS.

Keywords: Ischaemia-modified albumin; clomiphene citrate resistance; oxidative stress; polycystic ovary syndrome.

The aim of our study was to assess the effect of phototherapy (PT) on ischaemia-modified albumin (IMA) and malondialdehyde (MDA) levels in hyperbilirubinemic full-term newborns. The study was performed on 36 full-term infants exposed to PT. The babies were aged 3 to 13 days. IMA and MDA levels of the babies were determined before and after PT, by a colorimetric assay. IMA levels before and after PT were found as 0.424 ± 0.290 and 0.531 ± 0.262 absorbance units, respectively. Although IMA levels after PT were slightly higher, the difference was not statistically significant (p>> 0.131). MDA levels before and after PT were found as 8.4 ± 1.8 µmol/l and 9.4 ± 1.5 µmol/l, respectively. Serum MDA concentrations were significantly higher after PT than before PT (p < 0.000). In previous studies, conflicting findings have been reported about the effect of PT on oxidant and antioxidant systems. However, we have found no study investigating IMA levels in hyperbilirubinaemia in newborns before and after PT. Our results shows that PT does not affect IMA levels significantly. IMA increases as a result of oxidative stress. We believe that the lack of significant difference between our IMA levels before and after PT may resulted from hyperbilirubinaemia, which has antioxidant effect.

The pathogenesis of placenta percreta (PP) is not very well known. This study was designed to analyse the oxidative stress (OS), the thiol/disulphide balance, and ischaemia-modified albumin (IMA) the women with PP. The study included 38 pregnant women with PP and 40 similarly aged healthy pregnant women in their third trimester of gestation. We measured the IMA, native and total thiols, and disulphide concentrations in the maternal sera of all of the participating women. The IMA levels were higher and the native and total thiols were lower in the PP group than in the control group. However, there was no statistical significance with respect to the thiol/disulphide balance between the two groups. The results of this study suggest that an increase in the ischaemia and OS and a decrease in the antioxidant status may contribute to the pathogenesis of PP. Impact statement What is already known on this subject? Placenta percreta (PP) is a serious complication of pregnancy. Although there are several studies investigating the pathophysiological mechanism of PP, whether the pathology results from a lack of decidua or from the over-invasiveness of trophoblasts remains controversial. The pathology of PP is poorly understood. What do the results of this study add? This prospective study has shown an increased ischaemia modified albumin (IMA) and a decreased antioxidant capacity in the patients with placenta percreta. The results from 38 women with PP suggest that the serum concentrations of IMA and the oxidative stress parameters may be able to predict PP in cases of uncertainty. What are the implications of these findings for clinical practice and/or further research? The implication of these findings shed light on understanding the pathogenesis of PP for further research.

OBJECTIVE

Mechanical ventilation (MV) can induce oxidative stress, which plays a critical role in pulmonary injury in intubated neonates. Ischemia-modified albumin (IMA)-a variant of human serum albumin-is a novel biomarker of myocardial ischemia that occurs due to reactive oxygen species during ischemic insult. This study aimed to investigate IMA production due to oxidative stress induced during MV in neonates.

METHODS

This study included 17 neonates that were ventilated using synchronized intermittent mechanical ventilation (SIMV; SIMV group) and 20 neonates ventilated using continuous positive airway pressure (CPAP; CPAP group). Blood samples were collected from each neonate during ventilation support and following cessation of ventilation support. Total antioxidant capacity (TAC) and total oxidant status (TOS) were measured using the Erel method. IMA was measured via an enzyme-linked immunosorbent assay kit (Cusabio Biotech Co., Ltd., Wuhan, China). The oxidant stress index (OSI) was calculated as OSI = TOS/TAC. Statistical analysis was performed using SPSS v.18.0 (SPSS Inc., Chicago, IL) for Windows.

RESULTS

Among the neonates included in the study, mean gestational age was 34.7 ± 3.8 weeks, mean birth weight was 2,553 ± 904 g, and 54% were premature. There were not any significant differences in mean gestational age or birth weight between the SIMV and CPAP groups. Among the neonates in both the groups, mean IMA, TOS, and OSI levels were significantly higher during ventilation support (102.2 ± 9.3 IU mL(-1), 15.5 ± 1.3 µmol H2O2 equivalent L(-1), and 0.85 ± 0.22 arbitrary units [ABU], respectively), as compared with following cessation of ventilation support (82.9 ± 11.9 IU mL(-1), 13.4 ± 1.3 µmol H2O2 equivalent L(-1), and 0.64 ± 0.14 ABU, respectively) (p = 0.001). Among all the neonates in the study, mean TAC was significantly lower during ventilation support than the postventilation support (1.82 ± 0.28 mmol 6-hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid [Trolox] equivalent L(-1) vs. 2.16 ± 0.31 mmol Trolox equivalent L(-1)) (p = 0.001). There were no significant differences in mean TAC, OSI, or IMA levels between the SIMV and CPAP groups. The mean TOS level during ventilation support and the mean difference in TOS between during and postventilation support was significantly greater in the CPAP group than in the SIMV group. There were no significant relationships between the mean TOS, TAC, OSI, or IMA levels, and gestational age of the neonates.

CONCLUSIONS

SIMV and CPAP activated the oxidative stress and increased the IMA level in neonates; therefore, measurement of IMA and oxidant markers may be useful in the follow-up of lung injury in neonates due to ventilation support. Additional prospective studies are needed to compare the effects of various ventilation methods on oxidative stress and the IMA level in neonates.

This study was designed to evaluate umbilical cord ischaemia-modified albumin (IMA) levels and the cord blood gas parameters of foetuses with or without nuchal cords, at the time of elective C-section. The cross-sectional study population consisted of the patients who were admitted to the Tertiary Care Center between February and June 2015. Women with uncomplicated single term gestations between 37 and 40 completed weeks and scheduled for elective C-sections were included in the study. Fifty cases with a nuchal cord and 50 cases without a nuchal cord were recruited. Nuchal cord blood gas analysis and the IMA levels were evaluated. The IMA levels in umbilical artery of foetuses both in the study and control groups were similar (0.714 ± 0.150 vs. 0.689 ± 0.107 ABSU, p = .340, respectively). The umbilical artery pH values of the study group were significantly lower than that in the control group (7.31 ± 0.04 vs. 7.32 ± 0.03, p = .042; respectively). The results of the current study indicate that the nuchal cord has an impact on the foetal cord blood gas parameters to some extent before the initiation of labour. Fortunately, this impact does not end up with foetal tissue ischaemia, as confirmed by the IMA levels. Impact statement What is already known on this subject? The impact of nuchal cord on perinatal outcomes has been the subject of research for many years. Although the accumulated data has pointed out some unfavourable perinatal effects, the heterogeneity of the study groups both including a vaginal delivery and C-section and the inability to adjust the interfering factors ended up with some controversies. This is why there is not much known about the effects of the nuchal cord in women who are not in the labour process. What do the results of this study add? The current study aimed to exclude the interfering effects such as the active stage of labour. In this study, elective caesarean sections were selected as the study population to evaluate the effects of the nuchal cord on cord blood gas parameters and the IMA values. pH analysis in cord blood is used to detect hypoxia and the IMA is a new ischaemia marker. The results revealed that the in utero nuchal cord is associated with a significantly higher pCO2 and lower pH values and similar IMA values. What are the implications of these findings for clinical practice and/or further research? The final outcome supports that the nuchal cord causes alterations in cord blood gas analysis but this does not reach critical levels. Therefore, the results show that there is no need to change clinical practice when the nuchal cord is detected by ultrasound in a term gestation.

In recent years ischemia-modified albumin (IMA) has been suggested as a marker that can be used in differentiating nonconvulsive conditions from epilepsy. The purpose of this study was to investigate changes in IMA levels caused by generalized clonic tonic (GTC) seizures.

A total of 114 children presenting to the Karadeniz Technical Pediatric Emergency Polyclinic with GTC seizures were included in the study. Sixteen cases meeting the inclusion criteria were included in the study and sixteen healthy children were enrolled as the control group. The patients' IMA, albumin, and IMA/albumin values at hours 0 and 1 following the episode were compared with control group values.

IMA levels in the patient group were significantly higher at hour 1 compared to hour 0, and were also significantly higher than those of the control group levels at hour 1. In addition, the patient group IMA/albumin index value at hour 1 was significantly higher than the baseline value. IMA levels increased significantly with length of seizure.

Although there were no markers of hypoxia in patients undergoing GTC seizures in this study, hypoxia was observed to develop, and this caused serum IMA levels to rise in line with seizure duration.

In our study, we aimed to investigate ischemia modified albumin (IMA) as an oxidative stress marker, as well as other oxidant and antioxidant markers that have not been evaluated in children with celiac disease. A total of 37 pediatric patients who were diagnosed with celiac disease (CD) and 29 healthy children were enrolled in this prospective study. We evaluated the IMA, total oxidant status, total antioxidant capacity, sulfhydryl, and advanced oxidation protein products in all of the subjects. We also compared the levels at the time of the diagnosis, and following a gluten-free diet (GFD) in the children with CD. While the IMA and the other oxidant marker levels were significantly higher in the patient group compared to the control group, the antioxidant marker levels were found to be significantly lower in the patient group, compared to the control group. We also determined that the tissue transglutaminase IgA showed a highly positive correlation, and that the IMA showed a moderately positive correlation with the Marsh-Oberhuber histopathological stage. Additionally, the IMA and other oxidant marker levels were significantly lower, while the antioxidant marker levels were significantly higher after the GFD, compared to the pre-diet period. We detected that oxidative stress played a role in the pathogenesis of CD, and that this could be evaluated using oxidative stress markers, which would regress after the GFD. We also detected that IMA is a marker that shows a correlation with the histopathological stage, and may be used in the diagnosis.

Objective: The study aims to investigate maternal serum thiol/disulfide homeostasis and ischemia-modified albumin (IMA) levels of women who were submerged during labor. Material and methods: Sixty-four pregnant women were enrolled in this study. Thirty-four women were submerged during the first stage of labor and 30 women were not. Native thiol, total thiol, disulfide, albumin, IMA, disulfide/native thiol, disulfide/total thiol and native thiol/total thiol concentrations were measured and demographic data were obtained. Results: Cord blood pH, serum disulfide levels and (disulfide/total thiol) × 100 levels were significantly lower in the water immersion group (P < 0.01, P = 0.01 and P < 0.01, respectively). Native thiol, total thiol, albumin and IMA levels were higher in the water immersion group P < 0.01, P < 0.01, P = 0.001 and P < 0.01, respectively). Conclusion: Water immersion during the first stage of labor was found to be associated with deterioration of thiol-disulfide homeostasis with respect to antioxidant status while IMA levels were higher, suggesting an ischemic condition.

Inflammation parameters can predict the severity of coronary artery disease and predict long-term mortality. However, there is no study in which these parameters were evaluated together. We compared the prognostic values of inflammation parameters in predicting long-term mortality in patients with non-ST elevation acute coronary syndrome (NSTE-ACS). Consecutive patients with NSTE-ACS (n = 170) were included in the study. Monocyte/high-density lipoprotein cholesterol (HDL-C) ratio (MHR), lymphocyte/monocyte ratio (LMR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), total cholesterol/HDL-C ratio (TC/HDL-C), triglyceride /HDL-C ratio (TG/HDL-C), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index, and ischemia-modified albumin (IMA) were measured. Total antioxidant status and TOS variables were significant independent predictors of mortality. When 1.17 value is taken as a cutoff point of TAS values, the sensitivity (70.0%) and specificity (77.39%) values calculated for this value indicate that TAS variable has a predictive value on mortality. Monocyte/high-density lipoprotein cholesterol ratio, LMR, NLR, PLR, TC/HDL-C, TG/HDL-C, TOS, and IMA levels could not be used alone in the diagnosis, severity assessment, and predicting future mortality of NSTE-ACS. Only TAS levels had a predictive value on mortality.

Keywords: inflammation; mortality; non-ST acute coronary syndrome; oxidative stress; total antioxidant status.

BACKGROUND

Early atherosclerosis and increased risk of cardiovascular diseases (CVD) have been reported in patients with polycystic ovary syndrome (PCOS). Oxidative stress is an accepted risk factor for the development of CVD.

OBJECTIVE

To evaluate the association between oxidative stress markers [ischemia-modified albumin (IMA), total antioxidant status (TAS), and total oxidant status (TOS) levels], carotid intima- media thickness (CIMT), endocrine and metabolic parameters in patients with PCOS. MATERIALS, SUBJECTS, AND METHODS: We studied 52 patients with PCOS and 36 age- and body mass index (BMI)-matched controls. The diagnosis of PCOS was made according to the Rotterdam criteria. Metabolic, hormonal parameter and IMA, TAS, TOS levels were measured.

RESULTS

No statistically significant difference was determined in relation to age, BMI and waist-hip ratio, IMA, TAS, and TOS levels between groups. Mean IMA level was higher in PCOS patients, however, statistical significant difference was not observed. Mean CIMT and homeostasis model assessment of insulin resistance levels were significantly higher in patients with PCOS than in control subjects.

CONCLUSIONS

Our study has shown that although CIMT levels, showing CVD risk, were higher in PCOS patients, TAS and TOS oxidative stress markers were found to be similar between groups, IMA was higher in PCOS patients however the difference was not reach statistical significant. The present results suggest that CIMT increases before the state of ischemia and shows preischemic state of vasculature, while oxidative stress markers are considered to be indicators of ischemia and reperfusion injury in progressive vascular disease. Further studies are needed to show the association between oxidative stress markers, CVD and PCOS.

OBJECTIVE

The present study compared the unfavorable effects of protein oxidation and deoxyribonucleic acid damage on patients with white coat hypertension (WCH), sustained hypertension (HT), and normotensives.

METHODS

Participants were allocated into 3 groups: 40 healthy controls, 36 patients with WCH, and 40 patients with sustained HT. Patients with risk factors for atherosclerosis, endocrine diseases, alcoholism, or masked hypertension were excluded. Plasma level of protein carbonyl (PCO), ischemia modified albumin (IMA), total thiol (T-SH), prooxidant-antioxidant balance (PAB), advanced protein oxidation products (AOPPs), and urinary level of 8-hydroxy-2'-deoxyguanosine (8-OHdG) were measured and relationship between these oxidative stress parameters and WCH and sustained HT was analyzed.

RESULTS

Ambulatory 24-hour, daytime and night-time systolic and diastolic blood pressure readings of sustained HT group were significantly higher than those of WCH and control groups (p<0.001, all). AOPPs, PCO, IMA, 8-OHdG, and PAB levels were significantly higher in HT group than WCH and control groups (p<0.001, all). Additionally, T-SH level was significantly lower in HT group than WCH and control groups (p<0.001). A similar statistically significant relationship was detected between WCH and control groups.

CONCLUSIONS

Results indicate that increased level of AOPPs, PCO, IMA, 8-OHdG, PAB, and decreased level of T-SH are likely to be indicators of oxidative stress, which may play a key role both in WCH and sustained HT.

Undescended testis (UDT) is a common urological disorder. Patients with UDT have a risk of malignancy and infertility. The development of these conditions may be due to oxidative stress mediated by reactive oxygen species. The aim of this study was to investigate the relationship between these parameters by detecting oxidative DNA damage (8-hydroxy 2 deoxyguanosine/10⁶ deoxyguanosine), ischemia-modified albumin (IMA), malondialdehyde (MDA), and nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4) levels in children with UDT and healthy control group.

The blood samples were obtained from 30 patients with UDT and 40 healthy male subjects. The levels of oxidative DNA damage were detected by high-pressure liquid chromatography method. We used commercially available kits that use enzyme-linked immunosorbent assay method to measure IMA, MDA, and NOX4 levels.The levels of MDA, IMA, NOX4, and oxidative DNA damage in children with UDT were statistically significantly higher than control group. In addition, we found that the levels of NOX4, IMA, and oxidative DNA damage after 12 months of age was significantly higher than before 12 months of age.We identified increased lipid peroxidation, oxidative DNA damage, IMA, and NOX4 levels in children with UDT. Delay in the treatment of UDT may cause oxidative damage. That is why, according to us the antioxidant treatment may be beneficial in children with UDT.

Background: There is a crucial balance between oxidant and antioxidant defense mechanisms. We aimed to evaluate the role of the balance of these systems in children with bloodstream infection.

Methods: We analyzed prospectively oxidant and antioxidant stress parameters from serum samples of children with BSI besides demographic and clinical data of children. Serum levels of the total antioxidant status (TAS), total oxidant status (TOS), albumin, plasma thiol, disulphide, catalase (CAT), myeloperoxidase (MPO), ischemia-modified albumin (IMA) levels, ferroxidase and arylesterase (ARES) activity were evaluated in both patients and healthy controls.

Results: A total of 113 children were evaluated, 50 of them had bacteremia and the remaining 63 were healthy subjects. The median TOS values were 18.5 μmol H2O2/L and 13.1 μmol H2O2/L in patient and control groups, respectively with a statistically significant difference between groups. The mean serum IMA levels were 0.8 ± 0.1 absorbance unit (ABSU) in patients and 0.5 ± 0.09 ABSU in control, the difference between groups was statistically significant. The native thiol, total thiol levels and the disulphide levels were significantly lower in the patient group as compared with the control group. The myeloperoxidase level was 136 U/L in patients and 107 in controls with a statistically significant difference between groups.

Conclusions: TOS, IMA, MPO, and particularly plasma thiols seem good candidates for accurate diagnosis of bacteremia in children.

OBJECTIVE

N-acetylcysteine has been used to treat a variety of lung diseases, where is it thought to have an antioxidant effect. In a randomized placebo-controlled double-blind study, the effect of N-acetylcysteine on systemic inflammation and oxidative damage was examined in patients undergoing lung resection, a human model of acute lung injury.

METHODS

Eligible adults were randomized to receive preoperative infusion of N-acetylcysteine (240 mg/kg over 12 h) or placebo. Plasma thiols, interleukin-6, 8-isoprostane, ischaemia-modified albumin, red blood cell glutathione and exhaled breath condensate pH were measured pre- and post-operatively as markers of local and systemic inflammation and oxidative stress.

RESULTS

Patients undergoing lung resection and one-lung ventilation exhibited significant postoperative inflammation and oxidative damage. Postoperative plasma thiol concentration was significantly higher in the N-acetylcysteine-treated group. However, there was no significant difference in any of the measured biomarkers of inflammation or oxidative damage, or in clinical outcomes, between N-acetylcysteine and placebo groups.

CONCLUSIONS

Preoperative administration of N-acetylcysteine did not attenuate postoperative systemic or pulmonary inflammation or oxidative damage after lung resection.

BACKGROUND

NCT00655928 at ClinicalTrials.gov.

OBJECTIVE

Cardiopulmonary resuscitation (CPR) is a series of lifesaving actions that improve the chance of survival following cardiac arrest (CA). Many clinical and laboratory parameters, such as the presence of asystole, out-of-hospital CPR, and duration of cardiac arrest, are associated with failed CPR in patients with CA. Asystole is a state of no cardiac electrical activity, along with the absence of contractions of the myocardium and absence of cardiac output. Oxidative stress index (OSI), which is the ratio of total oxidative status to total antioxidant status, increases by ischemia-reperfusion injury. We investigated whether OSI levels in patients with CA could predict early mortality after CPR.

METHODS

This study has a prospective observational cohort design. Five patients with a history of cancer, four patients who developed hemolysis in their blood, six patients who were transferred to our hospital from other hospitals, and six patients in whom blood samples for OSI could not be stored properly were excluded. Finally, a total of 90 in-hospital or out-of-hospital CA patients and 40 age- and sex-matched healthy volunteers as the control group were evaluated prospectively. The patients were classified according to the CPR response into a successful group (n=46) and a failed group (n=44). Comparisons between groups were performed using one-way ANOVA with post hoc analysis by Tukey's HSD or independent samples t-test and the Kruskal-Wallis tests or Mann- Whitney U test for normally and abnormally distributed data, respectively. Also, we used chi-square test, Spearman's correlation test, univariate and multible logistic regression analyses, and receiver operator characteristic curve analysis.

RESULTS

OSI was 3.0±4.0, 5.6±4.3, and 8.7±3.8 in the control group, the successful CPR group, and the failed CPR group, respectively (p<0.001 for the 2 comparisons). OSI on admission, ischemia-modified albumin, presence of asystole, mean duration of cardiac arrest, out-of-hospital CPR, pH, and potassium and sodium levels were found to have prognostic significance in the univariate analysis. In the multivariate logistic regression model, OSI on admission (OR=1.325, p=0.003), ischemia-modified albumin (OR=1.008, p=0.005), presence of asystole (OR=13.576, p<0.001), and sodium level (OR=1.132, p=0.029) remained associated with an increased risk of early mortality. In addition, the optimal cut-off value of OSI to predict post-CPR mortality was measured as >6.02, with 84.1% sensitivity and 76.1% specificity.

CONCLUSIONS

Elevated OSI levels can predict failed CPR in CA patients.