The Role of Blood Lactate Levels as Outcome Predictor of Isolated Traumatic Brain Injury Patients

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R Laode
A Djoko
A Mansyur
B Burhanuddin

Keywords

traumatic, brain injury, lactate level, outcome

Abstract

Objectives: Traumatic brain injury (TBI) is accompanied by regional alterations of brain metabolism,
reduction in metabolic rates and possible energy crisis. This metabolic disturbance reflected by increase and
accumulation of the brain lactate levels. Objective of this study was to determine the correlation between
abnormalities in lactate metabolism for predicting neurologic outcome after moderate or severe traumatic brain
injury.
Methods: An observational prospective study in 60 patients with isolated TBI. Blood sample taken from vein
of the limbs after underwent initial resuscitation. Serial assessment of the blood lactate level was measured in
1st, 2nd and 7th day with Lact2 Roche Cobas® C-System. Neurologic outcome assessed on 7th days using
Modified GCS.
Results: On initial assessment, 38.3% of patients with normal lactate (≤ 2 mMol/L), 61.7% of patients was
hyperlactatemia ( > 2 mMol/L). In this study, it was obtained that the lower of GCS level, the higher of blood
lactate level, and vice versa (p = 0.033). In both treatment, there was a significant lactate clearance 24-hour as
37.96% ± 32.76 (p = 0.001) and 13.49% ± 40.32 (p = 0.011), respectively. No significant changes between
blood lactate level on the 2nd and 7th day, both operative (p = 0.938; p > 0.05) neither conservative (p = 0.280;
p > 0.05) patient. While, there was no correlation between neurologic outcome with 24-hour lactate clearance
(p = 0.349). The higher of the initial blood lactate level, the patient’s outcome was worsen (p = 0.029).
Conclusion: There is a significant correlation between blood lactate level and severity TBI according to GCS
level. The lower GCS level, the higher blood lactate level and vice versa. This study also demonstrates that 24-
hour lactate clearance did not affect patient’s outcome, but more influence by initial blood lactate level.
Therefore, initial blood lactate level can used as an outcome predictor in TBI patients.

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