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Open AccessArticle

Higher Serum Melatonin Levels during the First Week of Malignant Middle Cerebral Artery Infarction in Non-Surviving Patients

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Intensive Care Unit, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain
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Intensive Care Unit, Hospital Universitario Nuestra Señora de Candelaria, Crta del Rosario s/n, 38010 Santa Cruz de Tenerife, Spain
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Department of Physiology, Faculty of Medicine, University of the La Laguna, Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain
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Department of Radiology, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain
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Intensive Care Unit, Hospital General La Palma, Buenavista de Arriba s/n, 38713 La Palma, Breña Alta, Spain
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Intensive Care Unit, Hospital Clínico Universitario de Valencia, Avda. Blasco Ibáñez nº17-19, 46004 Valencia, Spain
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Intensive Care Unit, Hospital Universitario Dr. Negrín, CIBERES, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
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Intensive Care Unit, Hospital Insular, Plaza Dr. Pasteur s/n, 35016 Las Palmas de Gran Canaria, Spain
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Research Unit, Hospital Universitario de Canarias, Ofra s/n, 38320 La Laguna, Santa Cruz de Tenerife, Spain
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Department of Neurosurgery, Hospital Universitario de Canarias, Ofra s/n., 38320 La Laguna, Santa Cruz de Tenerife, Spain
*
Author to whom correspondence should be addressed.
Brain Sci. 2019, 9(12), 346; https://doi.org/10.3390/brainsci9120346
Received: 21 October 2019 / Revised: 22 November 2019 / Accepted: 27 November 2019 / Published: 28 November 2019
(This article belongs to the Section Clinical Neuroscience)
Objective: The activation of different physiopathological pathways (neuroinflammation, apoptosis, and oxidation) can lead to secondary brain injury in ischemic stroke, and in animal models the administration of melatonin has reduced that secondary injury. Lower levels of serum melatonin were found at the time of admission of cerebral infarction in surviving patients than in non-surviving patients. Thus, we carried out this prospective and observational study with the aim of exploring serum melatonin levels in the first week of a malignant middle cerebral artery infarction (MMCAI) in surviving and non-surviving patients, and to explore the capacity of those levels to predict mortality. Methods: Patients with severe MMCAI, defined as computed tomography showing acute infarction in more than 50% of the territory and Glasgow Coma Scale (GCS) lower than 9, were included in the study. We measured serum melatonin concentrations at days 1, 4, and 8 of MMCAI. Mortality at 30 days was the endpoint of our study. Results: Non-surviving patients (n = 34) compared to surviving patients (n = 34) showed higher serum melatonin levels at days 1 (p < 0.001), 4 (p < 0.001), and 8 (p = 0.001) of MMCAI. Serum melatonin concentrations at days 1, 4, and 8 of MMCAI had an area under the curve (AUC) (95% confidence interval (CI)) in the prediction of mortality of 0.89 (0.80–0.96; p < 0.001), 0.81 (0.68–0.91; p < 0.001), and 0.82 (0.68–0.92; p < 0.001), respectively. Conclusions: The novel findings of our study were that serum melatonin levels in the first week of MMCAI were higher in non-surviving patients, and were able to predict mortality. View Full-Text
Keywords: melatonin; malignant middle cerebral artery infarction; patients; mortality; prognosis melatonin; malignant middle cerebral artery infarction; patients; mortality; prognosis
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Lorente, L.; Martín, M.M.; Abreu-González, P.; Sabatel, R.; Ramos, L.; Argueso, M.; Solé-Violán, J.; Cáceres, J.J.; Jiménez, A.; García-Marín, V. Higher Serum Melatonin Levels during the First Week of Malignant Middle Cerebral Artery Infarction in Non-Surviving Patients. Brain Sci. 2019, 9, 346.

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