Temporal Kinetics of Circulating Oxidative Stress Markers in Intracerebral Hemorrhage and Their Association with Perihematoma Edema

In intracerebral hemorrhage (ICH), an elevated oxidant level may lead to perihematoma edema (PHE) and adversely affect its outcome. We report circulating oxidative stress markers in ICH patients at different time points and their association with PHE on computerized tomographic (CT) scans. A total of 87 patients with CT confirmed ICH within 24 h of ictus were prospectively included, and a follow-up CT scan was performed on day 7. The location and volume of hematoma, hematoma edema complex (HEC), PHE, and intraventricular extension of hemorrhage were noted on both CT scans. Blood samples were collected on days 1, 7, and 15, and reactive oxygen species (ROS), malondialdehyde (MDA), catalase (CAT), and glutathione peroxidase (GPx) levels were measured using a microplate reader. These biomarkers were also measured in 57 age-matched healthy controls. The patients had elevated ROS (p < 0.001) and MDA (p < 0.001) levels, whereas CAT (p < 0.001) and GPx (p < 0.001) levels were reduced compared to the controls. The oxidants remained elevated on day 7 and decreased on day 15 but did not reach the control levels. Furthermore, the CAT and GPx showed recovery on day 7 and day 15 but did not achieve the control levels. ROS (r = 0.28, p = 0.02) and GPx (r = −0.29, p = 0.02) correlated with PHE, suggesting their role in the pathogenesis. The hematoma volume, HEC, and PHE at day 1 correlated with the day 15 CAT level and MDA with PHE. At one month, 15 (17.24%) patients died, 56 (64.36%) had poor recovery, and 16 (18.39%) had good recovery. The patients with higher antioxidant levels had better survival and good outcomes. Future studies may investigate the efficacy of antioxidant therapy in improving clinical outcomes and modulating oxidative stress biomarkers in ICH patients.