{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T16:54:27Z","timestamp":1770137667441,"version":"3.49.0"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T00:00:00Z","timestamp":1615507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Subarachnoid hemorrhage (SAH) is a devastating disease with high morbidity and mortality. Hypoxia-induced changes and hemoglobin accumulation within the subarachnoid space are thought to lead to oxidative stress, early brain injury, and delayed vasospasm. This study aimed to evaluate the antioxidant status and its impact on neurological outcome in patients with aneurysmal SAH. Methods: In this prospective observational study, 29 patients with aneurysmal SAH were included (mean age 54.7 \u00b1 12.4). Blood and cerebrospinal fluid (CSF) samples were collected on days (d) 1, 3, and 7. In addition, 29 patients without intracranial hemorrhage served as controls. The antioxidant system was analyzed by glutathione peroxidase (GSH-Px; U\/L) and total and free glutathione-sulfhydryl (GSH; mg\/L) in the plasma. Superoxide dismutase (SOD, U\/mL) and total antioxidant capacity (TAC, \u00b5mol\/L) were measured in the serum and CSF. Clinical data were compiled on admission (Hunt and Hess grade, Fisher grade, and GCS). Neurological and cognitive outcome (modified Rankin scale (mRS), Glasgow Outcome Scale Extended (GOSE) and Montreal Cognitive Assessment (MoCA)) was assessed after 6 weeks (6 w) and 6 months (6 m). Results: Plasma levels of SOD increased from day 1 to 7 after SAH (d1: 1.22 \u00b1 0.36 U\/L; d3: 1.25 \u00b1 0.33 U\/L, p = 0.99; d7: 1.52 \u00b1 0.4 U\/L, p = 0.019) and were significantly higher compared to controls (1.11 \u00b1 0.27 U\/L) at day 7 (p &lt; 0.001). Concordantly, CSF levels of SOD increased from day 1 to 7 after SAH (d1: 1.22 \u00b1 0.41 U\/L; d3: 1.77 \u00b1 0.73 U\/L, p = 0.10; d7: 2.37 \u00b1 1.29 U\/L, p &lt; 0.0001) without becoming significantly different compared to controls (1.74 \u00b1 0.8 U\/L, p = 0.09). Mean plasma TAC at day 1 (d1: 77.87 \u00b1 49.72 \u00b5mol\/L) was not statistically different compared to controls (46.74 \u00b1 32.42 \u00b5mol\/L, p = 0.25). TAC remained unchanged from day 1 to 7 (d3: 92.64 \u00b1 68.58 \u00b5mol\/L, p = 0.86; d7: 74.07 \u00b1 54.95 \u00b5mol\/L, p = 0.8) in plasma. TAC in CSF steeply declined from day 1 to 7 in patients with SAH becoming significantly different from controls at days 3 and 7 (d3: 177.3 \u00b1 108.7 \u00b5mol\/L, p = 0.0046; d7: 85.35 \u00b1 103.9 \u00b5mol\/L, p &lt; 0.0001). Decreased SOD levels in plasma and CSF are associated with a worse neurological outcome 6 weeks (mRS: CSF p = 0.0001; plasma p = 0.027\/GOSE: CSF p = 0.001; plasma p = 0.001) and 6 months (mRS: CSF p = 0.001; plasma p = 0.09\/GOSE: CSF p = 0.001; plasma p = 0.001) after SAH. Increased plasma TAC correlated with a worse neurological outcome 6 weeks (mRS: p = 0.001\/GOSE p = 0.001) and 6 months (mRS p = 0.001\/GOSE p = 0.001) after SAH. Conclusion: In our study, a reduction in the antioxidative enzyme SOD and elevated TAC were associated with a poorer neurological outcome reflected by mRS and GOSE at 6 weeks and 6 months after SAH. A lower initial SOD CSF concentration was associated with the late deterioration of cognitive ability. These findings support the mounting evidence of the role of oxidative stress in early brain injury formation and unfavorable outcome after SAH.<\/jats:p>","DOI":"10.3390\/jcm10061188","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T11:56:55Z","timestamp":1615550215000},"page":"1188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Decreased Superoxide Dismutase Concentrations (SOD) in Plasma and CSF and Increased Circulating Total Antioxidant Capacity (TAC) Are Associated with Unfavorable Neurological Outcome after Aneurysmal Subarachnoid Hemorrhage"],"prefix":"10.3390","volume":"10","author":[{"given":"Harald","family":"Krenzlin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Wesp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Frenz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Kurz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1955-9827","authenticated-orcid":false,"given":"Julia","family":"Masomi-Bornwasser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Lotz","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3132-7543","authenticated-orcid":false,"given":"Florian","family":"Ringel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3983-3969","authenticated-orcid":false,"given":"Thomas","family":"Kerz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naureen","family":"Keric","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr.1, 55131 Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1111\/ijs.12006","article-title":"Age- and gender-specific time trend in risk of death of patients admitted with aneurysmal subarachnoid hemorrhage in the Netherlands","volume":"8","author":"Nieuwkamp","year":"2013","journal-title":"Int. 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