Der Einfluss von Laktat im Serum und Liquor, bezogen auf Mortalität und funktionelles Outcome nach Subarachnoidalblutung

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Aim of the study: Determining lactate via CMD in SAH patients is a method that is utilised extensively in clinical and scientific contexts. The majority of publications uses CMD lactate data as a foundation. Only a few studies have already analysed cerebrospinal fluid lactate gained from an EVD. The relation of lactate level variations, after SAH patients are no longer being sedated, has also not been sufficiently explored thus far. This study aims to determine whether lactate in cerebrospinal fluid and blood is a predictor of morbidity and mortality. Potential lactate developments, after sedation has ceased to be administered, shall also be analysed. Method: A retrospective observational study was carried out over a period of twelve years at the neurosurgery clinic of the Gießen University Hospital. The study only included patients with non-traumatic SAH, who were between the ages of 18 and 90 and had been intubated and ventilated during the course of their intensive care treatment. Another condition was that lactate must have, as part of the treatment, been searched for in several cerebrospinal fluid samples and arterial blood gas (ABG) analyses. Results: 147 patients in sum participated in the study. The patient cohort consisted of 98 (66.7 %) female and 49 (33.3 %) male patients. The median age of the cohort was 55 (IQR: 49–65) years. The average cerebrospinal fluid lactate level of deceased patients consisted of 4.48 mmol/l (SD ± 1.06). Patients who survived had an average cerebrospinal fluid lactate level of 3.24 mmol/l (SD ± 0.76). A poor outcome would ensue at an average cerebrospinal fluid lactate level of 4.08 mmol/l (SD ± 0.80). A positive outcome would be possible at 2.91 mmol/l (SD ± 0.55). These differences were highly significant in terms of mortality and the functional outcome. A threshold definition was determined via ROC analysis for these two aspects. In cases where the outcome was poor, the average cerebrospinal fluid lactate level possessed a cut-off value of 3.27 mmol/l, with an AUC of 0.91 and a Youden index of 0.69 (sensitivity: 90.91; specificity: 78.26). Conclusion: The study confirms the benefits of cerebrospinal fluid lactate levels with regard to mortality and the functional outcome. For a poor outcome, a threshold value of 3.27 to 4.08 mmol/l in SAH patients was determined, as it pertains to the analysed cohort.

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Jörg Focke

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