ABSTRACT
Background: Cortisol dynamics in serum might be related to clinical vasospasm, also known as delayed ischemic neurological deficits (DIND). Two vasoactive substances that play a role in pathophysiology of DIND are endothelin-1 (ET1) and nitric oxide (NO), both are proved associated with cortisol. This study aimed to know how cortisol plays a role on ET1/NO ratio and its relationship to DIND. Methods: This was a prospective cohort study for the first 14 days after aneurysmal subarachnoid hemorrhage (SAH). Patients with inclusion criteria will be enrolled for blood test before surgery, and post-operative day 2, 4, 7, and 10 (between 8:00-9:00 AM). The blood tests were performed for cortisol, ACTH, CBG, NO, and ET1. Free cortisol is calculated with Coolens equation. Logistic regression was used to see the interaction model and its scale. Bivariate analysis (corelation) was used to see the relationship between total cortisol, free cortisol, NO, ET1, and clinical vasospasm (DIND). Results: Forty-four patients were enrolled into this study (20 males; 24 females). Mean age was 52.02 ± 11.23 years. There were 29 patients (66%) within DIND group and 15 patients non-DIND as the control group. The mean of cortisol level shown was significantly higher in DIND group (35.99 ± 14.24) μg/dL compared to non-DIND group (19.57 ± 6.19) μg/dL, p < 0.001. The mean of free cortisol level was significantly higher in DIND group (2.06 ± 1.094) μg/dL compared to non-DIND group (0.838 ± 0.365 μg/dL; p < 0.001). The scatter plot graph showed that correlation of cortisol with ET1/NO ratio started increasing on day 4 and became stronger on day 10. Conclusion: Cortisol is associated with DIND following aneurysmal SAH, probably through its role in keeping the balance between ET1 and NO level.
Subject(s)
Nitric Oxide , Endothelin-1ABSTRACT
Background: This study was aimed to show differences in the mean values of Collagen I (Col I)/Nitric Oxide (NO), Collagen IV (Col IV)/NO, Tissue Factor (TF)/NO, and P-selectin (P-sel)/NO ratios between patients with DVT and those without DVT, following hip and knee meta-epiphyseal cancellous bone traumatization in major orthopedic surgeries. Methods: This is an observational prospective cohort study on 69 patients aged > 50 years, who had orthopedic surgery without thromboprophylaxis. Examination of serum Col I, Col IV, TF, P-sel, and NO biomarker levels were performed three times, i.e. before surgery, 72 hours and 144 hours after surgery. We looked for the differences in mean levels of biomarkers, and mean ratio values of the prothrombogenic/antithrombogenic (Col I/NO, Col IV/NO, TF/NO, P-sel/NO) at 72 hours and 144 hours post surgery between patients with DVT and those without. DVT events, which were confirmed at 144 hours post surgery by venography (with the exception of 8 cases where color Doppler ultrasound was done due to contrast usage contraindications). Results: DVTs were identified in 18 patients (26.1%). There were significant differences of mean levels in pre-surgical Col IV (p = 0.022) and 72 hours NO (p = 0.014) between patients with and without DVT. In addition, between the same two patient groups, significant differences were found in the mean values of the prothrombogenic/antithrombogenic ratios, i.e. Col IV/NO, TF/NO, and P-sel/NO at 72 hours post-surgery (p = 0.007, p = 0.028, and p = 0.049 respectively), with lower median values that were found in subjects with DVT. At 144-hours post surgery, the only significant ratio difference between the two groups was the mean values of Col IV/NO ratio (p = 0.014) with the median values that were higher than the median values at 72-hours post surgery . Conclusion: The incidence of DVT following traumatization of the meta-epiphyseal cancellous bone after major orthopedic surgeries in hip and knee is influenced by the balance of prothrombogenic and antithrombogenic factors as shown by the significant differences in Col IV/NO, TF/NO and P-sel/NO ratios at 72-hours and Col IV/NO ratio at 144 hours after surgery between DVT positive and DVT negative patients.