Role of ischemic modified albumin in the early diagnosis of increased intracranial pressure and brain death

Abstract

AIM: Increased intracranial pressure following trauma and subsequent possible development of brain death are important factors for morbidity and mortality due to ischemic changes. We aimed to establish the role of ischemic modifi ed albumin (IMA) in the early diagnosis of the process, starting with increased intracranial pressure and ending with brain death. MATERIALS AND METHODS: Eighteen Wistar-Albino rats were divided into three groups; control (CG, n = 6), increased intracranial pressure (ICPG, n = 6), and brain death (BDG, n = 6). Intracranial pressure elevation and brain death were constituted with the infl ation of a balloon of a Fogarty catheter in the epidural space. In all three groups, blood samples were drawn before the procedure, and at minutes 150 and 240 for IMA and malondialdehyde (MDA) analysis. RESULTS: Serum IMA levels at 150 and 240 minutes were higher in ICPG than in CG (p < 0.05). IMA levels were similar in ICPG and BDG. Serum MDA levels at 150 and 240 minutes increased in ICPG and BDG groups compared to CG (p < 0.05). MDA levels were similar in ICP and BD groups. CONCLUSION: IMA should be considered as a biochemical parameter in the process starting from increased intracranial pressure elevation and ending at brain death (Tab. 3, Fig. 5, Ref. 31). Text in PDF www.elis.sk. KEY WORDS: ischemic modifi ed albumin, increased intracranial pressure, brain death.

Ischemia-modified Albumin as a Biomarker for Prediction of Poor Outcome in Patients With Traumatic Brain Injury: An Observational Cohort Study

“…Moreover, we identified cut-off values of IMA predictive of mortality with high sensitivity and specificity. The findings of our study might be attributed to the production of oxygen free radicals after TBI as a result of ischemia and/or hypoxia, acidosis and reperfusion, all of which are considered important features of secondary brain injury processes 6,10,13…”

“…5 These results also support the findings of the current study. Although still theoretical, a study by Kara et al 13 suggested that IMA might have potential as a biomarker of increased intracranial pressure and brain death; they found that IMA was elevated in both scenarios in comparison to baseline readings. Data presented as statistical significance with 95% confidence interval of the area under the curve, sensitivity and specificity of the cut-off values of IMA on day 0 and day to predict mortality.…”

“…The findings of our study might be attributed to the production of oxygen free radicals after TBI as a result of ischemia and/or hypoxia, acidosis and reperfusion, all of which are considered important features of secondary brain injury processes. 6,10,13 Although IMA was originally investigated as a predictor for early cardiac ischemia, there are a variety of data investigation IMA in patients with ischemia of noncardiac origin, including ischemic and hemorrhagic stroke, pulmonary embolism, tumors, systemic sclerosis, peripheral vascular disease, skeletal muscle ischemia, glaucoma, and diabetes mellitus. 7,[13][14][15][16] In a study in patients with intracerebral hemorrhage, cerebral infarction, transient ischemic attack, and epileptic seizures, Abboud et al 17 reported significantly higher IMA levels in the patient groups compared with controls.…”

“…6,10,13 Although IMA was originally investigated as a predictor for early cardiac ischemia, there are a variety of data investigation IMA in patients with ischemia of noncardiac origin, including ischemic and hemorrhagic stroke, pulmonary embolism, tumors, systemic sclerosis, peripheral vascular disease, skeletal muscle ischemia, glaucoma, and diabetes mellitus. 7,[13][14][15][16] In a study in patients with intracerebral hemorrhage, cerebral infarction, transient ischemic attack, and epileptic seizures, Abboud et al 17 reported significantly higher IMA levels in the patient groups compared with controls. An interesting explanation for the increase in IMA in patients suffering from ischemic stroke in this study was its attribution to the presence of an ischemic penumbra and subsequent reperfusion.…”

Ischemia-Modified Albumin: Origins and Clinical Implications

“…Various underlying mechanisms, including caspase and metalloproteinase activation, mitochondrial dysfunction, excessive glial activation, inflammatory reactions, and compromised microcirculation, are associated with increased ICP [115][116][117]. In line with that, Kara et al have shown that increased intracerebral pressure in rats due to injury, hematoma, or cerebral edema leads to increased IMA levels in the blood [118]. Moreover, IMA levels correlate with the amount of TBARS in the blood, and both can serve as additional markers for increased intracerebral pressure and can be valuable in predicting brain death.…”