Abstract
Endothelium-derived nitric oxide is beneficial in experimental stroke. We assessed
plasma NO levels in patients with acute stroke and their association with both severity
and outcome. Plasma nitric oxide (NO), assessed as nitrate/nitrite (NOx), cyclic guanosine
monophosphate (cGMP, second messenger to NO), L-arginine (substrate for NO) and L-citrulline
(co-product with NO) levels were measured in 228 patients with acute ischemic stroke,
49 patients with acute hemorrhagic stroke, and 38 age and gender-matched normal volunteers.
Stroke severity was assessed using the Glasgow Coma Scale, and the outcome was judged
by discharge destination (home, institution, or dead). In our study, stroke patients
had low levels of NOx (μmol/l): ischemic 49.9 (26.1); hemorrhage 41.7 (19.5); and
control 64.0 (36.3) (P <.001); L-arginine (μmol/l): ischemic 85.1 (32.3); hemorrhage 69.9 (24.4); and control
104.0 (30.0) (P <.001); and L-citrulline (μmol/l): ischemic 30.5 (12.3); hemorrhage 26.7 (12.1);
and control 39.4 (13.5) (P <.001). Cyclic GMP levels were elevated in stroke: ischemic 21.2 (16.1); hemorrhage
24.7 (17.5); and control 15.8 (9.2) (P =.024). Patients who died or became institutionalized had lower NOx, L-arginine,
and L-citrulline levels, and higher cyclic GMP levels, than patients who were discharged
home. NOx levels were not associated with feeding status in patients. Low levels of
NOx are present in stroke and are associated with severity and outcome. Because endothelium-derived
NO is beneficial in acute stroke, administering NO might be beneficial in acute stroke.
Copyright © 2003 by National Stroke Association
Keywords
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Article info
Publication history
Accepted:
November 20,
2002
Received:
June 13,
2002
Footnotes
*Supported in part by grants from the NHS Health Technology Assessment programme (grant 93/03/31) and The Stroke Association. P.B. was Wolfson Senior Lecturer in Stroke Medicine (London) and is Stroke Association Professor of Stroke Medicine (Nottingham). Presented in part at the World Stroke Conference, Melbourne 2000.
29
**Address reprint requests to Professor Philip Bath, Division of Stroke Medicine, University of Nottingham, City Hospital campus, Nottingham NG5 1PB UK. E-mail: [email protected]
★1052-3057/03/1202-0001$30.00/0
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© 2003 National Stroke Association. Published by Elsevier Inc. All rights reserved.
