The impact of admission serum lactate on children with moderate to severe traumatic brain injury

English version

Autoři: Yue-qiang Fu ^aff001; Ke Bai ^aff001; Cheng-jun Liu ^aff001
Působiště autorů: Department of Critical Care Medicine, Children’s Hospital, Chongqing Medical University, Chongqing, China ^aff001; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China ^aff002; Chongqing Key Laboratory of Pediatrics, Chongqing, China ^aff003
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0222591

Souhrn

Background

Lactate is used to evaluate the prognosis of adult patients with trauma. However, the prognostic significance of admission serum lactate in the setting of pediatric traumatic brain injury (TBI) is still unclear. We aim to investigate the impact of admission lactate on the outcome in children with moderate to severe TBI.

Methods

This retrospective study was conducted in a tertiary pediatric hospital between May 2012 and Jun 2018 included children with an admission Glasgow Coma Scale (GCS) of ≤13. Two hundred and thirteen patients were included in the analysis and 45 patients died in hospital.

Results

Admission lactate and glucose were significantly higher in non-survivors than those in survivors (P < 0.05). Admission lactate was positively correlated with admission glucose and negatively correlated with GCS in all patients (n = 213), subgroup of isolated TBI (n = 112) and subgroup of GCS ≤ 8 (n = 133), respectively. AUCs of lactate could significantly predict the mortality and were higher than those of glucose in all patients, subgroup of isolated TBI and subgroup of GCS ≤ 8, respectively. Multivariate logistic regression showed that admission lactate (Adjusted OR = 1.189; 95% CI: 1.002–1.410; P = 0.047) was independently associated with mortality, while admission glucose (Adjusted OR = 1.077; 95% CI: 0.978–1.186; P = 0.133) wasn’t an independent risk factor of death. Elevated admission lactate (> 2 mmol/L) was associated with death, reduced 14-day ventilation-free days, 14-day ICU-free days and 28-day hospital-free days.

Conclusions

Admission serum lactate can effectively predict the mortality of children with moderate to severe TBI. Elevated admission lactate is associated with death, reduced ventilator-free, ICU-free, and hospital-free days. Admission serum lactate could be used as a prognostic biomarker of mortality in children with moderate to severe TBI.

Klíčová slova:

Biology and life sciences – Biochemistry – Physical sciences – Chemistry – Proteins – Population biology – Medicine and health sciences – Chemical compounds – Organic compounds – Carbohydrates – Monosaccharides – Organic chemistry – Population metrics – Death rates – Critical care and emergency medicine – Pediatrics – Health care – Health care facilities – Hospitals – Hemoglobin – Neurology – Glucose – Epidemiology – Medical risk factors – Trauma medicine – Traumatic injury – Intensive care units – Neurotrauma – Traumatic brain injury – Coma

Zdroje

1. Anderson VA, Catroppa C, Haritou F, Morse S, Rosenfeld JV. Identifying factors contributing to child and family outcome 30 months after traumatic brain injury in children. J Neurol Neurosurg Psychiatry. 2005; 76(3):401–408. doi: 10.1136/jnnp.2003.019174 15716536.

2. Bowman SM, Bird TM, Aitken ME, Tilford JM. Trends in hospitalizations associated with pediatric traumatic brain injuries. Pediatrics. 2008; 122(5):988–993. doi: 10.1542/peds.2007-3511 18977977.

3. Fu YQ, Chong SL, Lee JH, Liu CJ, Fu S, Loh TF, et al. The impact of early hyperglycaemia on children with traumatic brain injury. Brain Inj. 2017; 31(3):396–400. doi: 10.1080/02699052.2016.1264629 28296528.

4. Pal JD, Victorino GP, Twomey P, Liu TH, Bullard MK, Harken AH. Admission serum lactate levels do not predict mortality in the acutely injured patient. J Trauma. 2006; 60(3):583–587; discussion 587–589. doi: 10.1097/01.ta.0000205858.82575.55 16531858.

5. Venkatesan M, Smith RP, Balasubramanian S, Khan A, Uzoigwe CE, Coats TJ, et al. Serum lactate as a marker of mortality in patients with hip fracture: A prospective study. Injury. 2015; 46(11):2201–2205. doi: 10.1016/j.injury.2015.06.038 26337798.

6. Parsikia A, Bones K, Kaplan M, Strain J, Leung PS, Ortiz J, et al. The predictive value of initial serum lactate in trauma patients. Shock. 2014; 42(3):199–204. doi: 10.1097/SHK.0000000000000208 24978889.

7. Régnier MA, Raux M, Le Manach Y, Asencio Y, Gaillard J, Devilliers C, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology. 2012; 117(6):1276–1288. doi: 10.1097/ALN.0b013e318273349d 23168430.

8. Richards JE, Matuszewski PE, Griffin SM, Koehler DM, Guillamondegui OD, OʼToole RV, et al. The Role of Elevated Lactate as a Risk Factor for Pulmonary Morbidity After Early Fixation of Femoral Shaft Fractures. J Orthop Trauma. 2016; 30(6):312–318. doi: 10.1097/BOT.0000000000000528 27206261.

9. Brown JB, Lerner EB, Sperry JL, Billiar TR, Peitzman AB, Guyette FX. Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level. J Trauma Acute Care Surg. 2016;81(3):445–452. doi: 10.1097/TA.0000000000001085 27116410; PubMed Central PMCID: PMC5001911.

10. Paladino L, Sinert R, Wallace D, Anderson T, Yadav K, Zehtabchi S. The utility of base deficit and arterial lactate in differentiating major from minor injury in trauma patients with normal vital signs. Resuscitation. 2008; 77(3):363–368. doi: 10.1016/j.resuscitation.2008.01.022 18367305.

11. Gale SC, Kocik JF, Creath R, Crystal JS, Dombrovskiy VY. A comparison of initial lactate and initial base deficit as predictors of mortality after severe blunt trauma. J Surg Res. 2016; 205(2):446–455. doi: 10.1016/j.jss.2016.06.103 27664895.

12. Londoño J, Niño C, Díaz J, Morales C, León J, Bernal E, et al. Association of Clinical Hypoperfusion Variables With Lactate Clearance and Hospital Mortality. Shock. 2018; 50(3):286–292. doi: 10.1097/SHK.0000000000001066 29206763.

13. Okello M, Makobore P, Wangoda R, Upoki A, Galukande M. Serum lactate as a predictor of early outcomes among trauma patients in Uganda. Int J Emerg Med. 2014; 7:20. doi: 10.1186/s12245-014-0020-9 25097669; PubMed Central PMCID: PMC4105872.

14. Kong VY, Weale RD, Laing GL, Bruce JL, Oosthuizen GV, Sartorius B, et al. A raised serum lactate level is an independent predictor of in-hospital mortality in patients with isolated cerebral gunshot wounds. S Afr Med J. 2018; 108(5):413–417. doi: 10.7196/SAMJ.2018.v108i5.12837 29843856.

15. Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH. The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000, 190(6):656–664. 10873000.

16. Richards JE, Scalea TM, Mazzeffi MA, Rock P, Galvagno SM Jr. Does Lactate Affect the Association of Early Hyperglycemia and Multiple Organ Failure in Severely Injured Blunt Trauma Patients? Anesth Analg. 2018; 126(3):904–910. doi: 10.1213/ANE.0000000000002626 29283920.

17. Dekker SE, de Vries HM, Lubbers WD, van de Ven PM, Toor EJ, Bloemers FW, et al. Lactate clearance metrics are not superior to initial lactate in predicting mortality in trauma. Eur J Trauma Emerg Surg. 2017; 43(6):841–851. doi: 10.1007/s00068-016-0733-y 27738727.

18. Kaplan LJ, Kellum JA. Initial pH, base deficit, lactate, anion gap, strong ion difference, and strong ion gap predictoutcome from major vascular injury. Crit Care Med. 2004; 32(5):1120–1124. doi: 10.1097/01.ccm.0000125517.28517.74 15190960.

19. Raux M, Le Manach Y, Gauss T, Baumgarten R, Hamada S, Harrois A, et al. Comparison of the Prognostic Significance of Initial Blood Lactate and Base Deficit in Trauma Patients. Anesthesiology. 2017; 126(3):522–533. doi: 10.1097/ALN.0000000000001490 28059838.

20. Martin M, Fitzsullivan E, Salim A, Brown C, Demetriades D, Long W. Discordance between lactate and base deficit in the surgical intensive care unit: which one do you trust? American Journal of Surgery. 2006; 191(5): 625–630. doi: 10.1016/j.amjsurg.2006.02.014 16647349.

21. Ouellet JF, Roberts DJ, Tiruta C, Kirkpatrick AW, Mercado M, Trottier V, et al. Admission base deficit and lactate levels in Canadian patients with blunt trauma: are they useful markers of mortality? Journal of Trauma Acute Care and Surgery. 2012; 72(6), 1532–1535. doi: 10.1097/TA.0b013e318256dd5a 22695417.

22. Ramanathan R, Parrish DW, Hartwich JE, Haynes JH. Utility of admission serum lactate in pediatric trauma. J Pediatr Surg. 2015; 50(4):598–603. doi: 10.1016/j.jpedsurg.2014.08.013 25840070.

23. Shah A, Guyette F, Suffoletto B, Schultz B, Quintero J, Predis E, et al. Diagnostic accuracy of a single point-of-care prehospital serum lactate for predicting outcomes in pediatric trauma patients. Pediatr Emerg Care. 2013; 29(6):715–719. doi: 10.1097/PEC.0b013e318294ddb1 23714761.

24. Chong SL, Harjanto S, Testoni D, Ng ZM, Low CY, Lee KP, et al. Early Hyperglycemia in Pediatric Traumatic Brain Injury Predicts for Mortality, Prolonged Duration of Mechanical Ventilation, and Intensive Care Stay. Int J Endocrinol. 2015; 2015:719476. doi: 10.1155/2015/719476 26074963; PubMed Central PMCID: PMC4446478.

25. Sammour T, Kahokehr A, Caldwell S, Hill AG. Venous glucose and arterial lactate as biochemical predictors of mortality in clinically severely injured trauma patients—a comparison with ISS and TRISS. Injury. 2009; 40(1):104–108. doi: 10.1016/j.injury.2008.07.032 19117566.

26. Quintard H, Patet C, Zerlauth JB, Suys T, Bouzat P, Pellerin L, et al. Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio. J Neurotrauma. 2016; 33(7):681–687. doi: 10.1089/neu.2015.4057 26421521; PubMed Central PMCID: PMC4827289.

27. Glenn TC, Martin NA, Horning MA, McArthur DL, Hovda DA, Vespa P, et al. Lactate: brain fuel in human traumatic brain injury: a comparison with normal healthy controlsubjects. J Neurotrauma. 2015; 32(11):820–832. doi: 10.1089/neu.2014.3483 25594628; PubMed Central PMCID: PMC4530406.

28. Lama S, Auer RN, Tyson R, Gallagher CN, Tomanek B, Sutherland GR. Lactate storm marks cerebral metabolism following brain trauma. J Biol Chem. 2014; 289(29):20200–20208. doi: 10.1074/jbc.M114.570978 24849602; PubMed Central PMCID: PMC4106336.

29. Stefani MA, Modkovski R, Hansel G, Zimmer ER, Kopczynski A, Muller AP, et al. Elevated glutamate and lactate predict brain death after severe head trauma. Ann Clin Transl Neurol. 2017; 4(6):392–402. doi: 10.1002/acn3.416 28589166; PubMed Central PMCID: PMC5454398.

30. Meierhans R, Brandi G, Fasshauer M, Sommerfeld J, Schüpbach R, Béchir M, et al. Arterial lactate above 2 mM is associated with increased brain lactate and decreased brain glucose in patients with severe traumatic brain injury. Minerva Anestesiol. 2012; 78(2):185–193. 21971438.

31. Odom SR, Howell MD, Silva GS, Nielsen VM, Gupta A, Shapiro NI, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013; 74(4):999–1004. doi: 10.1097/TA.0b013e3182858a3e 23511137.