Nitric Oxide Metabolite Concentration in Cerebrospinal Fluid: Useful as a Prognostic Marker?

Abstract

Study DesignProspective study.PurposeTo establish the significance of cerebrospinal fluid (CSF) nitric oxide metabolite (NOx) concentration in acute spinal cord injury (SCI) patients to assess the neurological severity and prognosis.Overview of LiteratureQuantitative analysis of specific biomarkers in CSF will assess neurological severity more accurately and permit the formulation of a more precise management plan.MethodsForty SCI patients represented the cases and 20 lower limb injury patients were the controls. NOx concentration in CSF was measured at week 1, 2, and 4 by Griess method. Magnetic resonance imaging (MRI, T2-weighted) done in each case to measure cord edema and neurological severity was assessed using the Frankel classification.ResultsCSF NOx concentration peaked at week 2 and declined to normal by week 4. The concentration remained normal in controls. Mean NOx concentration was directly proportional to the severity of acute SCI as correlated with cord edema seen in MRI and neurological severity assessed.ConclusionsCSF NOx concentration can be considered a specific quantitative biomarker in acute stage of SCI to predict the severity and prognosis of SCI patients.

Blood Serum Cytokines in Patients with Subacute Spinal Cord Injury: A Pilot Study to Search for Biomarkers of Injury Severity

“…A retrospective comparative analysis of the data we obtained from blood serum at 2 weeks post-injury with published CSF data is not possible due to differences in experimental design and patient selection. To our knowledge, the only study of 2 weeks post-injury CSF was conducted by Singh et al (2016), which described an elevated CSF concentration of nitric oxide within motor complete paraplegia/quadriplegia SCI patients, compared to those with some spared motor function [ 17 ]. Other studies have assessed the level of some cytokines within the CSF in traumatic brain injury (TBI) patients.…”

“…It is considered that cerebrospinal fluid (CSF) is more representative for SCI severity assessment given its proximity to the spinal cord [ 11 ]. In this regard, most investigators focus on determining the post-traumatic levels of CSF biomarkers between SCI patients with different baseline American Spinal Injury Association Impairment Scale (AIS) grades [ 12 , 16 , 17 , 18 , 19 ]. Nonetheless, the clinical management of SCI patients does not suggest that routine CSF collection, for which there are contraindications and the risk of complications, is the best approach.…”