The diagnostic role of oxidative stress parameters and lymphocyte DNA damage in discrimination of acute ischemic and hemorrhagic stroke

Objective: This study aimed to analyse whether serum oxidative stress parameters and lymphocyte DNA damage have predictive value in the discrimination of stroke type and determination of disease severity in adult patients diagnosed with acute stroke via clinical and radiological findings in the emergency department. Materials and Methods: A total of 66 adult patients who admitted to the Department of Emergency Medicine, Bezmialem Vakif University Faculty of Medicine between May 2014 and October 2014 and diagnosed with acute stroke were prospectively included in the study. Of the cases, 42 were ischemic stroke and 24 were hemorrhagic stroke. As a control group, 35 eligible healthy volunteers were enrolled. Differential diagnosis was established through patients' history, physical examination, laboratory and imaging methods and the patients participating in the study were divided into two groups as ischemic stroke and hemorrhagic stroke cases. In both patient groups, total oxidant status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) levels and the level of lymphocyte DNA damage were studied within the first 24 hours after the onset of symptoms. Based on medical history and physical examination, ischemic and hemorrhagic stroke cases were classified according to the National Institutes of Health Stroke Scale or NIH Stroke Scale (NIHSS) into three groups as group 1(NIH scores ranging from 0-6 points, mild-moderate); group2 (NIH scores ranging from, 7-15 points, moderate-severe) and group 3 (NIH scores ranging from 16-42 points, severe-very severe) As oxidative stress parameters, TOS, TAS and OSI values and DNA damage levels were compared between the groups. Results: When compared with the control group, TAS, TOS and OSI values and the level of lymphocyte DNA damage were found to be significantly higher in patients with stroke compared with those in the controls (all comparisons, p<0.05). When the patients were classified into subgroups with respect to stroke type, serum TOS and TAS values were significantly higher in ischemic stroke than hemorrhagic stroke (both comparisons, p<0.001). However, there was no significant difference in OSI values and DNA damage levels in either group of patients (both comparisons, p>0.05). When the patients were classified into subgroups with respect to NIH Stroke Scale, no significant difference was observed between the groups 1 and 3 in terms of TAS, TOS and OSI values (all comparisons, p>0.05 for all parameters). However, a significantly higher plasma lymphocyte DNA damage levels were observed in group 3 who had severe stroke (between-group comparison for all three groups, p <0.001). Conclusion: We conclude that plasma TOS and TAS values, as the biomarkers of oxidative stress, can help to determine the type of stroke with radiologic imaging studies in patients with stroke in the early period. In addition, lymphocyte DNA levels can be regarded as an objective alternative criterion to the stroke assessment tools in identifying the initial severity of stroke patients.