van Donkelaar Carlina E, Dijkland Simone A, van den Bergh Walter M, Bakker Jan, Dippel Diederik W, Nijsten Maarten W, van der Jagt Mathieu
1Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 2Department of Intensive Care, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. 3Department of Neurology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands.
Crit Care Med. 2016 May;44(5):966-72. doi: 10.1097/CCM.0000000000001569.
In critically ill patients, elevated blood lactate at admission is associated with poor outcome, but after aneurysmal subarachnoid hemorrhage, this has not been investigated. We studied the association between early circulating lactate and glucose with delayed cerebral ischemia and poor outcome. Lactate and glucose were both studied, hypothesizing that both may be increased due to sympathetic activation after subarachnoid hemorrhage similar to critically ill patients.
Retrospective cohort study.
ICUs of two academic hospitals in the Netherlands.
Patients with aneurysmal subarachnoid hemorrhage admitted to the ICU within 24 hours after the bleed surviving beyond 48 hours after ICU admission and who had at least one lactate measurement within 24 hours after admission.
None.
In 285 patients, maximal lactate and glucose levels within the first 24 hours after admission were determined. Early lactate and glucose were related with delayed cerebral ischemia-related infarction and poor outcome (a modified Rankin Scale score of 4, 5, or death at 3 mo). Delayed cerebral ischemia occurred in 84 patients (29%), and 106 patients (39%) had poor outcome. Multivariable analyses were performed with adjustment of established predictors for delayed cerebral ischemia and outcome: age, sex, World Federation of Neurological Surgeons grade at admission and Hijdra sum scores. Early lactate and glucose were strongly related (Spearman ρ = 0.55; p < 0.001). Lactate and glucose were both independently associated with delayed cerebral ischemia and poor outcome in multivariable analyses with either lactate or glucose as covariates. When both lactate and glucose were included, only glucose showed an independent association with delayed cerebral ischemia (odds ratio, 1.14; 95% CI, 1.01-1.28) and only lactate showed an independent association with poor outcome (odds ratio, 1.42; 95% CI, 1.11-1.81).
Early lactate and glucose levels after aneurysmal subarachnoid hemorrhage are associated with delayed cerebral ischemia and poor outcome, suggesting that they may be considered in conjunction with other parameters for future prognostic models.
在危重症患者中，入院时血乳酸升高与预后不良相关，但动脉瘤性蛛网膜下腔出血后，尚未对此进行研究。我们研究了早期循环乳酸和葡萄糖与迟发性脑缺血及预后不良之间的关联。同时研究了乳酸和葡萄糖，推测两者可能因蛛网膜下腔出血后交感神经激活而升高，这与危重症患者情况类似。
回顾性队列研究。
荷兰两家学术医院的重症监护病房。
动脉瘤性蛛网膜下腔出血患者，出血后24小时内入住重症监护病房，入住重症监护病房48小时后存活，且入院后24小时内至少进行过一次乳酸测量。
无。
对285例患者测定了入院后最初24小时内的最大乳酸和葡萄糖水平。早期乳酸和葡萄糖与迟发性脑缺血相关梗死及预后不良（改良Rankin量表评分在3个月时为4、5或死亡）相关。84例患者（29%）发生迟发性脑缺血，106例患者（39%）预后不良。进行多变量分析时对迟发性脑缺血和预后的既定预测因素进行了校正：年龄、性别、入院时世界神经外科联合会分级及Hijdra总分。早期乳酸和葡萄糖密切相关（Spearman ρ = 0.55；p < 0.001）。在以乳酸或葡萄糖作为协变量的多变量分析中，乳酸和葡萄糖均与迟发性脑缺血及预后不良独立相关。当同时纳入乳酸和葡萄糖时，仅葡萄糖与迟发性脑缺血独立相关（比值比，1.14；95%可信区间，1.01 - 1.28），仅乳酸与预后不良独立相关（比值比，1.42；95%可信区间，1.11 - 1.81）。
动脉瘤性蛛网膜下腔出血后早期乳酸和葡萄糖水平与迟发性脑缺血及预后不良相关，提示在未来的预后模型中，它们可与其他参数一起考虑。
