Clinical impact of intraoperative hyperlactatemia during craniotomy


Autoři: Diana Romano aff001;  Stacie Deiner aff001;  Anjali Cherukuri aff004;  Bernard Boateng aff005;  Raj Shrivastava aff002;  J. Mocco aff002;  Constantinos Hadjipanayis aff002;  Raymund Yong aff002;  Christopher Kellner aff002;  Kurt Yaeger aff002;  Hung-Mo Lin aff006;  Jess Brallier aff007
Působiště autorů: Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff001;  Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff002;  Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff003;  University of Central Florida College of Medicine, Orlando, FL, United States of America aff004;  Alabama College of Osteopathic Medicine, Dothan, AL, United States of America aff005;  Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America aff006;  Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America aff007
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224016

Souhrn

Object

Patients often develop markedly elevated serum lactate levels during craniotomy although the reason for this is not entirely understood. Elevated lactate levels have been associated with poor outcomes in critically ill septic shock patients, as well as patients undergoing abdominal and cardiac surgeries. We investigated whether elevated lactate in craniotomy patients is associated with neurologic complications (new neurological deficits) as well as systemic complications.

Methods

We performed a cohort study of elective craniotomy patients. Demographic and intraoperative data were collected, as well as three timed intraoperative arterial lactate values. Additional lactate, creatinine and troponin values were collected immediately postoperatively as well as 12 and 24 hours postoperatively. Assessment for neurologic deficit was performed at 6 hours and 2 weeks postoperatively. Hospital length-of-stay and 30-day mortality were collected.

Results

Interim analysis of 81 patients showed that no patient had postoperative myocardial infarction, renal failure, or mortality within 30 days of surgery. There was no difference in the incidence of new neurologic deficit in patients with or without elevated lactate (10/26, 38.5% vs. 15/55 27.3%, p = 0.31). Median length of stay was significantly longer in patients with elevated lactate (6.5 vs. 3 days, p = 0.003). Study enrollment was terminated early due to futility (futility index 0.16).

Conclusion

Elevated intraoperative serum lactate was not associated with new postoperative neurologic deficits, other end organ events, or 30 day mortality. Serum lactate was related to longer hospital stay.

Klíčová slova:

Blood – Brain damage – Hospitals – Lesions – Surgical and invasive medical procedures – Vascular surgery – Craniotomy – Renal failure


Zdroje

1. Barker FG. Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: The effect of provider caseload and centralization of care. Neuro Oncol. 2005;7(1):49–63. doi: 10.1215/S1152851704000146 15701282

2. Kohli-Seth R, Mukkera SR, Leibowitz AB, Nemani N, Oropello JM, Manasia A, et al. Frequency and Outcomes of Hyperlactatemia After Neurosurgery: A Retrospective Analysis. ICU Dir. 2011;2(6):211–4.

3. Brallier JW, Dalal PJ, McCormick PJ, Lin HM, Deiner SG. Elevated Intraoperative Serum Lactate during Craniotomy Is Associated with New Neurological Deficit and Longer Length of Stay. J Neurosurg Anesthesiol. 2017;29(4):388–92. doi: 10.1097/ANA.0000000000000332 27438799

4. Allen M. Lactate and acid base as a hemodynamic monitor and markers of cellular perfusion. Pediatr Crit Care Med. 2011;12(4 SUPPL.).

5. Max B, Weil H, Ph D. Experimental and Clinical Studies on Lactate and Pyruvate; Circulation 1970.Pdf. 1970;

6. Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Lactate Levels. 2014;88(10):1127–40.

7. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest. 1991;99(4):956–62. doi: 10.1378/chest.99.4.956 2009802

8. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent J-L. Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg. 1996;171(2):221–6. doi: 10.1016/S0002-9610(97)89552-9 8619454

9. Husain FA, Martin MJ, Mullenix PS, Steele SR, Elliott DC. Serum lactate and base deficit as predictors of mortality and morbidity. Am J Surg. 2003;185(5):485–91. doi: 10.1016/s0002-9610(03)00044-8 12727572

10. McNelis J, Marini CP, Jurkiewicz A, Szomstein S, Simms HH, Ritter G, et al. Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit. Am J Surg. 2001;182(5):1–5.

11. Li S, Peng K, Liu F, Yu Y, Xu T, Zhang Y. Changes in blood lactate levels after major elective abdominal surgery and the association with outcomes: A prospective observational study. J Surg Res. 2013;184(2):1059–69. doi: 10.1016/j.jss.2013.04.056 23721936

12. Ranucci M, De Toffol B, Isgrò G, Romitti F, Conti D, Vicentini M. Hyperlactatemia during cardiopulmonary bypass: Determinants and impact on postoperative outcome. Crit Care. 2006;10(6):1–9.

13. Maillet J-M, Le Besnerais P, Cantoni M, Nataf P, Ruffenach A, Lessana A, et al. Frequency, Risk Factors, and Outcome of Hyperlactatemia After Cardiac Surgery. Chest. 2003;123(5):1361–6. doi: 10.1378/chest.123.5.1361 12740248

14. Mariappan R, Venkatraghavan L, Vertanian A, Agnihotri S, Cynthia S, Reyhani S, et al. Serum lactate as a potential biomarker of malignancy in primary adult brain tumours. J Clin Neurosci. 2015;22(1):144–8. doi: 10.1016/j.jocn.2014.06.005 25172017

15. Bharadwaj S, Venkatraghavan L, Mariappan R, Ebinu J, Meng Y, Khan O, et al. Serum lactate as a potential biomarker of non-glial brain tumors. J Clin Neurosci. 2015;22(10):1625–7. doi: 10.1016/j.jocn.2015.05.009 26100160

16. Balaka C, Stranjalis G, Kalamatianos T, Koutsarnakis C, Bouras T, Boviatsis E, et al. Perioperative microdialysis in meningioma surgery: correlation of cerebral metabolites with clinical outcome. Acta Neurochir (Wien). 2014;156(12):2275–82.

17. Alagona G, Coco M, Rapisarda G, Costanzo E, Maci T, Restivo D, et al. Changes of blood lactate levels after repetitive transcranial magnetic stimulation. Neurosci Lett. 2009;450(2):111–3. doi: 10.1016/j.neulet.2008.11.064 19084051

18. Cata JP, Bhavsar S, Hagan KB, Arunkumar R, Grasu R, Dang A, et al. Intraoperative serum lactate is not a predictor of survival after glioblastoma surgery. J Clin Neurosci. 2017;43:224–8. doi: 10.1016/j.jocn.2017.05.004 28601568

19. Jo YY, Kim JY, Choi JJ, Jung WS, Kim YB, Kwak HJ. Preoperative serum lactate cannot predict in-hospital mortality after decompressive craniectomy in traumatic brain injury. J Anesth. 2016;30(4):637–43. doi: 10.1007/s00540-016-2169-2 27043453

20. Akcil EF, Dilmen OK, Karabulut ES, Koksal SS, Altindas F, Tunali Y. Effective and safe mannitol administration in patients undergoing supratentorial tumor surgery: A prospective, randomized and double blind study. Clin Neurol Neurosurg. 2017;159(April):55–61.

21. Carpenter KLH, Jalloh I, Hutchinson PJ. Glycolysis and the significance of lactate in traumatic brain injury. Front Neurosci. 2015;9(APR):1–15.

22. Rice AC, Zsoldos R, Chen T, Wilson MS, Alessandri B, Hamm RJ, et al. Lactate administration attenuates cognitive deficits following traumatic.pdf. 2018;928(2002):156–9.

23. Holloway R, Zhou Z, Harvey HB, Levasseur JE, Rice AC, Sun D, et al. Effect of lactate therapy upon cognitive deficits after traumatic brain injury in the rat. Acta Neurochir (Wien). 2007;149(9):919–27.

24. Dinc N, Platz J, Tritt S, Quick-Weller J, Eibach M, Wolff R, et al. Posterior fossa AVMs: Increased risk of bleeding and worse outcome compared to supratentorial AVMs. J Clin Neurosci [Internet]. 2018;53:171–6. Available from: https://doi.org/10.1016/j.jocn.2018.04.010 29685412

25. Dangayach NS, Grewal HS, De Marchis GM, Sefcik RK, Bruce R, Chhatlani A, et al. Does the obesity paradox predict functional outcome in intracerebral hemorrhage? J Neurosurg [Internet]. 2017;129(November):1–5. Available from: http://thejns.org/doi/10.3171/2017.5.JNS163266

26. Bagheri M, Speakman JR, Shabbidar S, Kazemi F, Djafarian K. A dose-response meta-analysis of the impact of body mass index on stroke and all-cause mortality in stroke patients: A paradox within a paradox. Obes Rev. 2015;16(5):416–23. doi: 10.1111/obr.12272 25753533

27. Barba R, Marco J, Ruiz J, Canora J, Hinojosa J, Plaza S, et al. The obesity paradox in stroke: Impact on mortality and short-term readmission. J Stroke Cerebrovasc Dis. 2015;24(4):766–70. doi: 10.1016/j.jstrokecerebrovasdis.2014.11.002 25670014


Článek vyšel v časopise

PLOS One


2019 Číslo 10