Hemorajik Ve İskemik Serebrovasküler Hastalık Tanısı Alan Hastalarda Kan Laktat Düzeyinin Prognoz Üzerine Etkisi

Year 2021, Volume: 43 Issue: 2, 115 - 121, 30.03.2021

Turgay Çağlayan Engin Özakın , Atilla Özcan Özdemir , Nurdan Acar , Mustafa Emin Çanakçı , Ebubekir Arslan Hakan Dolgun Filiz Kaya

https://doi.org/10.20515/otd.796303

Cited By: 1

Abstract

Çalışmamızın amacı iskemik ve hemorajik inme tanısı alan hastalarda, venöz kan laktat değerinin prognoz üzerine etkisinin araştırılmasıdır. Çalışmamıza, (Eskişehir Osmangazi Üniversitesi Tıp Fakültesi cil servisine başvuran ve 12 saatten kısa süreli iskemik veya hemorajik inme tanısı alan 18 yaş üstü hastalar dahil edildi. Hastaların demografik bilgileri, ilk başvuru ve 24. saat venöz kan laktat düzeyleri ve) National Institutes of Health Stroke Scale (NIHSS), bilgisayarlı tomografi (BT) bulguları ve 3. ay modifiye Ranson skalası (mRs) kayıt edildi ve aralarındaki ilişki değerlendirildi. Çalışmaya 51’i (%58) erkek, 72’si (%81,8) iskemik, inme tanısı alan toplam 88 hasta dahil edildi. İskemik inme tanısı alan 7 (%8) hastada infarkt alanı 2/3’den büyük olduğu çekilen BT'de görüldü. Başvuru ve 24. saat venöz kan laktat düzeyleri medyan değerleri sırasıyla: 1,6 mmol/L, 1,4 mmol/l ve azalma istatistiksel olarak anlamlı idi (0-24 Saat p=0,019, p<0,001). İskemik inmeli hastalarda ilk venöz kan laktat düzeyi, infarkt alanı büyüklüğü MCA sulama alanının 2/3’ünden büyük olanların, küçük olanlara göre daha yüksek idi (p=0,013). Hemorajik inmelerde ise ilk başvuru venöz kan laktat düzeylerinin iskemik inmeye göre daha yüksek idi (2.05 e karşı 1,55 mmol/l, p=0,043). Başvuru ve 24. saat laktat düzeyleri ile NIHSS ve mRs arasında anlamlı ilişki tespit edilemedi. İnme hastalarında venöz kan laktat düzeyi ölçümü, kanama tipi ve iskemik infarkt alanı büyüklüğünün belirlenmesinde ve inme yönetiminde acil tıp hekimlerine yardımcı olabilir.

Keywords

inme, laktat, venöz, prognoz, iskemik, kanama

Supporting Institution

Yok

Project Number

-

The Effect of Blood Lactate Level on Prognosis in Patients with Hemorrhagic and Ischemic Cerebrovascular Disease

Abstract

The aim of our study is to investigate the relationship between venous blood lactate levels and prognosis in ischemic and hemorrhagic stroke patients. Patients over 18 years of age who applied to Eskişehir Osmangazi Univesrsity Faculty of Medicine emergency service and diagnosed with ischemic or hemorrhagic stroke for less than 12 hours were included in our study. The demographic information of the patients, initial and 24th hour venous blood lactate levels and National Institutes of Health Stroke Scale (NIHSS), Computed Tomography (CT) findings and 3rd month modified Rankin scale (mRs) were recorded and the relationship between them was evaluated. A total of 88 patients, 51 (58%) male, 72 (81.8%) diagnosed with ischemic stroke, were included in the study. In 7 (8%) patients diagnosed with ischemic stroke, the infarct area larger than 2/3 was seen on CT. The median values of venous blood lactate levels at admission and 24 hours were 1.6 mmol / L, 1.4 mmol / L, respectively and the decrease was statistically significant (0-24 Hours p = 0.019, p <0.001). In patients with ischemic stroke, the first venous blood lactate level was higher in those with infarct size greater than 2/3 of the MCA irrigation area compared to the smaller ones (p = 0.013). In hemorrhagic strokes, initial venous blood lactate levels were higher than in ischemic stroke (2.05 vs 1.55 mmol / l, p = 0.043). No significant correlation was found between NIHSS and mRs with lactate levels at admission and 24 hours. Measurement of venous blood lactate level in stroke patients can assist emergency physicians in determining the type of bleeding and the size of the ischemic infarct site and in stroke management.

Keywords

Stroke, lactate, NIHSS, mRs

Project Number

-

References

• 1. Feigin VL, Lawes CMM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003 Jan;2(1):43–53.
• 2. El-Saed Aiman, Kuller Lewis H., Newman Anne B., Lopez Oscar, Costantino Joseph, McTigue Kathleen, et al. Geographic Variations in Stroke Incidence and Mortality Among Older Populations in Four US Communities. Stroke. 2006 Aug 1;37(8):1975–9.
• 3. Khosravani H, Shahpori R, Stelfox H, Kirkpatrick A, Laupland K. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Critical care. 2009;
• 4. Cerović O, Golubović V, Spec-Marn A, Kremzar B, Vidmar G. Relationship between injury severity and lactate levels in severely injured patients. Intensive Care Med. 2003 Aug;29(8):1300–5.
• 5. Cevik AA, Dolgun H, Oner S, Tokar B, Acar N, Ozakin E, et al. Elevated lactate level and shock index in nontraumatic hypotensive patients presenting to the emergency department. Eur J Emerg Med. 2015 Feb;22(1):23–8.
• 6. Nicoli F, Lefur Y, Denis B, Ranjeva JP, Confort-Gouny S, Cozzone PJ. Metabolic counterpart of decreased apparent diffusion coefficient during hyperacute ischemic stroke: a brain proton magnetic resonance spectroscopic imaging study. Stroke. 2003 Jul;34(7):e82-87.
• 7. Predictive Value of Neurochemical Monitoring in Large Middle Cerebral Artery Infarction | Stroke [Internet]. [cited 2020 Sep 16]. Available from: https://www.ahajournals.org/doi/full/10.1161/01.str.32.8.1863
• 8. Brouns R, Sheorajpanday R, Wauters A, De Surgeloose D, Mariën P, De Deyn PP. Evaluation of lactate as a marker of metabolic stress and cause of secondary damage in acute ischemic stroke or TIA. Clin Chim Acta. 2008 Nov;397(1–2):27–31.
• 9. Wyss MT, Jolivet R, Buck A, Magistretti PJ, Weber B. In Vivo Evidence for Lactate as a Neuronal Energy Source. J Neurosci. 2011 May 18;31(20):7477–85.
• 10. New Evidence of Neuroprotection by Lactate after Transient Focal Cerebral Ischaemia: Extended Benefit after Intracerebroventricular Injection and Efficacy of Intravenous Administration - FullText - Cerebrovascular Diseases 2012, Vol. 34, No. 5-6 - Karger Publishers [Internet]. [cited 2020 Sep 16]. Available from: https://www.karger.com/Article/Fulltext/343657
• 11. Cureton EL, Kwan RO, Dozier KC, Sadjadi J, Pal JD, Victorino GP. A different view of lactate in trauma patients: protecting the injured brain. J Surg Res. 2010 Mar;159(1):468–73.
• 12. T H, J K. Neuroprotective effects of lactate in brain ischemia: dependence on anesthetic drugs. Neurochem Int. 2013 Jan 5;62(3):251–7.
• 13. Jo S, Jeong T, Lee JB, Jin YH, Yoon J, Jun YK, et al. Initial hyperlactatemia in the ED is associated with poor outcome in patients with ischemic stroke. Am J Emerg Med. 2012 Mar;30(3):449–55.
• 14. Oddo M, Levine JM, Frangos S, Maloney-Wilensky E, Carrera E, Daniel RT, et al. Brain lactate metabolism in humans with subarachnoid hemorrhage. Stroke. 2012 May;43(5):1418–21.
• 15. Dienel GA. Brain lactate metabolism: the discoveries and the controversies. J Cereb Blood Flow Metab. 2012 Jul;32(7):1107–38.
• 16. Neuroprotective Role of Lactate after Cerebral Ischemia - Carole Berthet, Hongxia Lei, Jonathan Thevenet, Rolf Gruetter, Pierre J Magistretti, Lorenz Hirt, 2009 [Internet]. [cited 2020 Sep 17]. Available from: https://journals.sagepub.com/doi/10.1038/jcbfm.2009.97
• 17. Associations Between Diffusion and Perfusion Parameters, N-Acetyl Aspartate, and Lactate in Acute Ischemic Stroke | Stroke [Internet]. [cited 2020 Sep 17]. Available from: https://www.ahajournals.org/doi/full/10.1161/strokeaha.108.525626
• 18. Persson L, Hillered L. Chemical monitoring of neurosurgical intensive care patients using intracerebral microdialysis. J Neurosurg. 1992 Jan;76(1):72–80.
• 19. Parsons MW, Li T, Barber PA, Yang Q, Darby DG, Desmond PM, et al. Combined (1)H MR spectroscopy and diffusion-weighted MRI improves the prediction of stroke outcome. Neurology. 2000 Aug 22;55(4):498–505.