Plasma Glutathione and Cystine as Risk Markers for Severity and Disability in the Acute Hemorrhagic Stroke

Background/Objectives: Glutathione (GSH) and its precursor cysteine (Cys) plays an important role in the neuronal injury process in stroke. We evaluate the association of cysteine and glutathione forms in blood plasma with the severity and disability of acute hemorrhagic stroke. Methods: A total of 64 patients (39-59 years old) with intracerebral (n=12) or subarachnoid hemorrhage (n=52) were examined. The patients' conditions were estimated using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Results: The median levels of plasma cystine (CysS) and reduced glutathione (rGSH) were 51.1 and 1.04 µM, respectively. Patients with high levels (≥50 μM) of CysS had a significantly higher frequency of mild or moderate neurological impairment (NIHSS≤10) than patients with levels of CysS<50 µM (OR=7.73, CI95% 2.19-27.28). Also, patients with high levels (≥1.9 μM) of rGSH had a significantly higher frequency of mild disability (mRS≤2) compared to patients with rGSH<1.9 µM (OR=12.35, CI95% 3.43-44.5). Conclusions: CysS and rGSH levels are associated with a reduced risk of high neurological deficit and disability, respectively, in the acute period of hemorrhagic stroke. These indicators could be used to evaluate neurologic impairment severity of stroke patient. Further research is needed to determine potential of circulating free thiols as biomarkers and to evaluate the usefulness of GSH-targeting therapy in acute hemorrhagic stroke.