Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department

Abstract

Background: Serum lactate is a useful biomarker for prediction of mortality in critically ill patients. The purpose of this study was to identify if serum lactate could be used as a biomarker for predicting mortality in patients with subarachnoid hemorrhage (SAH) in the emergency department. Methods: This retrospective study enrolled 189 patients. Baseline demographic data and clinical characteristics of patients were obtained from medical record review. Multiple logistic regression analysis was performed to determine predictor variables significantly associated with mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of variables for mortality prediction in SAH. Results: Using multivariate logistic regression analysis, age [OR 1.05; 95% confidence interval (CI) 1.00-1.10; p = 0.037], Hunt and Hess scale score (OR 3.29; 95% CI 1.62-6.70; p = 0.001), serum lactate level (OR 1.33; 95% CI 1.03-1.74; p = 0.032), and serum glucose level (OR 1.01; 95% CI 1.00-1.02; p = 0.049) predicted overall mortality in SAH. The area under the ROC curve (AUC) value for the use of serum lactate level to predict mortality in SAH was 0.815 (95% CI 0.753-0.868) (p < 0.001). Conclusion: Serum lactate may be a useful biomarker for the early prediction of mortality in SAH patients in the emergency department.

The Prognostic Role of Lactate Concentrations after Aneurysmal Subarachnoid Hemorrhage

“…In patients with SAH, most studies have focused on cerebral lactate concentrations assessed by microdialysis or jugular bulb catheters and have reported a relationship between high lactate concentrations, cerebral ischemia, and poor outcome [ 12 , 13 , 14 ]. However, the prognostic value of early systemic lactate concentrations in these patients is still poorly defined: Although some studies reported an association between early high lactate concentrations and poor outcome [ 15 , 16 , 17 , 18 ], others did not [ 19 ].…”

“…Moreover, most studies focused on either the first lactate measurement on admission or the highest lactate concentration in the first 24 h [ 15 , 16 , 17 ]; the evolution of lactate kinetics in the acute phase of SAH was addressed in only one study [ 17 ]. We therefore investigated the evolution of blood lactate concentrations in the first days after aSAH to determine their association with outcome.…”

Lactate dehydrogenase predicting mortality in patients with aneurysmal subarachnoid hemorrhage

“…Our findings are still significant after including other important biomarkers which were not included in previous studies: troponin T, 16,17,23 neutrophil count, 17,23 C-reactive-protein, 16,17 blood glucose, 17 and procalcitonin. 16,17,23 Third, the mortality data are accurate and complete, since death records were extracted from household registration data. 19,20 Fourth, this study also obtained continuous LDH levels for a month after admission, and thus, this study further assessed the impact of trajectory, median, and max LDH levels.…”

“…In a study of 189 patients with spontaneous SAH in the emergency department, serum lactate is associated with shortterm in-hospital mortality, but the study was hampered by the case-control design and limited follow-up. 23 However, the present study offers several advantages over previous studies. First, our study is large, with 3524 patients, which yielded great precision in estimates.…”

“…The findings showed that a higher preoperative serum LDH level was associated with functional neurological outcomes at 3 months. In a study of 189 patients with spontaneous SAH in the emergency department, serum lactate is associated with short‐term in‐hospital mortality, but the study was hampered by the case–control design and limited follow‐up 23 . However, the present study offers several advantages over previous studies.…”