A Different View of Lactate in Trauma Patients: Protecting the Injured Brain

Cureton, Elizabeth L.; Kwan, Rita O.; Dozier, Kristopher C.; Sadjadi, Javid; Pal, Jay D.; Victorino, Gregory P.

doi:10.1016/j.jss.2009.04.020

Cited by 52 publications

(50 citation statements)

References 23 publications

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“…With respect to isolated TBI, the data about the elevation of serum lactate in patients with isolated head injury and their prognostic value are conflicting [18,19]. In our study, lactate is the parameter with the highest AUC in the ROC curve analysis for death and sepsis in patients with isolated TBI, although it was not an independent predictor for either endpoint.…”

Section: Discussioncontrasting

confidence: 64%

“…Our results contrast those of Zehtabchi et al [19], who found no correlation between the severity of brain injury and arterial lactate, which may be due to the fact that their study also included patients without intracranial lesions on CT. Cureton et al [18] did find a correlation between the severity of TBI and admission lactate in their study on 555 TBI patients. Because of better survival in patients with lactate[5 mmol/L, the authors even suggested a protective effect following brain injury.…”

Section: Discussionmentioning

confidence: 89%

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Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Dübendorfer

Billeter

Seifert

et al. 2012

Eur J Trauma Emerg Surg

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Objective Arterial lactate, base excess (BE), lactate clearance, and Sequential Organ Failure Assessment (SOFA) score have been shown to correlate with outcome in severely injured patients. The goal of the present study was to separately assess their predictive value in patients suffering from traumatic brain injury (TBI) as opposed to patients suffering from injuries not related to the brain. Materials and methods A total of 724 adult trauma patients with an Injury Severity Score (ISS) C 16 were grouped into patients without TBI (non-TBI), patients with isolated TBI (isolated TBI), and patients with a combination of TBI and non-TBI injuries (combined injuries). The predictive value of the above parameters was then analyzed using both uni-and multivariate analyses. Results The mean age of the patients was 39 years (77 % males), with a mean ISS of 32 (range 16-75). Mortality ranged from 14 % (non-TBI) to 24 % (combined injuries). Admission and serial lactate/BE values were higher in nonsurvivors of all groups (all p \ 0.01), but not in patients with isolated TBI. Admission SOFA scores were highest in nonsurvivors of all groups (p = 0.023); subsequently septic patients also showed elevated SOFA scores (p \ 0.01), except those with isolated TBI. In this group, SOFA score was the only parameter which showed significant differences between survivors and non-survivors. Receiver operating characteristic (ROC) analysis revealed lactate to be the best overall predictor for increased mortality and further septic complications, irrespective of the leading injury. Conclusion Lactate showed the best performance in predicting sepsis or death in all trauma patients except those with isolated TBI, and the differences were greatest in patients with substantial bleeding. Following isolated TBI, SOFA score was the only parameter which could differentiate survivors from non-survivors on admission, although the SOFA score, too, was not an independent predictor of death following multivariate analysis.

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Section: Discussioncontrasting

confidence: 64%

Section: Discussionmentioning

confidence: 89%

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Dübendorfer

Billeter

Seifert

et al. 2012

Eur J Trauma Emerg Surg

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“…This latter mechanism provides vital tissues an alternative oxidisable substrate when glucose is unavailable as a result of the hypoinsulinaemic state of DKA. We hypothesise that, as in patients with isolated traumatic brain injury where cerebral hyperglycolysis is associated with a better neurological outcome,8 patients with DKA might benefit from their hyperlactataemia. A recently published observational study from Cox et al ,4 where they could not demonstrate a relation between the degree of hyperlactataemia and ICU length of stay in patients with DKA, is not in contradiction with this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

Lactic acidosis in diabetic ketoacidosis

et al. 2014

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We describe the case of a 22-year-old man with insulin-dependent diabetes, who was admitted to the emergency department with hypotension, unconsciousness and a severe combined diabetic ketoacidosis (DKA) and lactic acid acidosis. In the discussion, we focus on the pathophysiological mechanisms underlying lactic acidosis in DKA, and we elaborate on the prognostic value of hyperlactataemia on such occasion.

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“…Several observations indicate neuroprotective effects of lactate in conditions such as brain ischemia or brain trauma (40, 76,369,370). After traumatic cerebral injury, the brain appears to switch from glucose to lactate as a the main fuel (138).…”

Section: L-lactate: Transmitter and Fuelmentioning

confidence: 99%

Neuroglial Transmission

Gundersen

Storm‐Mathisen

Bergersen

2015

Physiological Reviews

146

113

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Neuroglia, the "glue" that fills the space between neurons in the central nervous system, takes active part in nerve cell signaling. Neuroglial cells, astroglia, oligodendroglia, and microglia, are together about as numerous as neurons in the brain as a whole, and in the cerebral cortex grey matter, but the proportion varies widely among brain regions. Glial volume, however, is less than one-fifth of the tissue volume in grey matter. When stimulated by neurons or other cells, neuroglial cells release gliotransmitters by exocytosis, similar to neurotransmitter release from nerve endings, or by carrier-mediated transport or channel flux through the plasma membrane. Gliotransmitters include the common neurotransmitters glutamate and GABA, the nonstandard amino acid d-serine, the high-energy phosphate ATP, and l-lactate. The latter molecule is a "buffer" between glycolytic and oxidative metabolism as well as a signaling substance recently shown to act on specific lactate receptors in the brain. Complementing neurotransmission at a synapse, neuroglial transmission often implies diffusion of the transmitter over a longer distance and concurs with the concept of volume transmission. Transmission from glia modulates synaptic neurotransmission based on energetic and other local conditions in a volume of tissue surrounding the individual synapse. Neuroglial transmission appears to contribute significantly to brain functions such as memory, as well as to prevalent neuropathologies.

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A Different View of Lactate in Trauma Patients: Protecting the Injured Brain

Cited by 52 publications

References 23 publications

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Serial lactate and admission SOFA scores in trauma: an analysis of predictive value in 724 patients with and without traumatic brain injury

Lactic acidosis in diabetic ketoacidosis

Neuroglial Transmission

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