Association of thiol-disulfide and oxidized-reduced glutathione homeostasis with severity and clinical prognosis of post-stroke patients

Background Stroke is among the most common causes of all deaths and Disability-Adjusted Life Years (DALYs) in the world. There is a close relationship between stroke pathophysiology and post-stroke clinic with oxidative stress. Thiol-disulfide homeostasis systems, which is one of the important extracellular and intracellular oxidative stress markers, showing antioxidant capacity with SH form, and oxidative status with disulfide (SS) form. In this study, we aimed to evaluate the relationship between the clinical outcome of subacute stroke patients and extracellular thiol-disulfide (SH-SS) and intracellular oxidized-reduced glutathione (GSSG-GSH) homeostasis and the comparison of these with healthy volunteers. In addition, the effect of the rehabilitation program on these oxidative stress markers and clinical scores and the predictive value of these oxidative stress parameters on prognosis were also evaluated. Materials and Methods In this study, which was designed as a prospective observational study, patients with subacute stroke who had a stroke for the first time and were admitted to the hospital for the first rehabilitation treatment and healthy volunteers (control group) were included. The clinical conditions of the patients were evaluated at the beginning and after the 4-week rehabilitation program at the time of discharge by National Institues Of Healt Stroke Scale Scores (NIHSS), modified Rankin Scale (mRS) and Barthel Daily Living Activities Index (BI). Serum and whole blood samples were obtained from the patient group at the beginning and at discharge, and from the control group. The SH-SS homeostasis parameters (SH, Total SH, SS and SS / SH percent ratio) from serum samples and GSSG-GSH homeostasis parameters (GSH, Total GSH, GSSG and GSSG / GSH percentage ratio) from whole blood samples were determined. Results 42 patients and 35 healthy volunteers were included in the study. No significant difference was found between the patient and control groups in terms of age and gender (p> 0.05). SH and GSH values were significantly lower and SS, GSSG, SS / SH percent ratio and GSSG / GSH percent ratio values were significantly higher in the patient group at the beginning and at discharge than the control group values (p <0.05 for all). SH, GSH and BI values significantly increased and SS, GSSG, SS / SH percentage ratio, GSSG / GSH percentage ratio, NIHSS and mRS values significantly decreased after the rehabilitation (p <0.05 for all). The pre-treatment SS / SS percent ratio, GSSG / GSH percent ratios were positively correlated with pre- and post-treatment NIHSS and mRS scores, and negatively correlated with pre- and post-treatment BI scores (p <0.05 for all). There was a significant relationship between the increase in SH and GSH levels with the decrease in NIHSS scores and the increase in BI scores (p <0.05 for all). Conclusion In this study, it was shown that the parameters of extracellular SH-SS and intracellular GSSG-GSH homeostasis shifted towards the oxidative side of the balances in subacute stroke patients, and this situation was associated with poor clinical outcomes determined by NIHSS, BI and mRS scores. In addition, it was shown that the antioxidant sides of these balances and clinical evaluation scores improved with the rehabilitation program. It has been concluded that the parameters in these balances may be potentially useful indicators for determining the clinical prognosis in subacute stroke patients. Since relationship between improvement in clinical evaluation scores and increase in antioxidant capacities in these balances were shown, it was concluded that supplements containing thiol group such as N-acetyl cysteine, and lipoic acid may potentially contribute to achieving better clinical results in stroke patients.