Elevated Serum Lactate Correlates With Intracranial Hemorrhage in Neonates Treated With Extracorporeal Life Support

Grayck, Eva Nozik; Meliones, Jon N.; Kern, Frank H.; Hansell, Doug; Ungerleider, Ross M.; Greeley, William J.

doi:10.1542/peds.96.5.914

Cited by 29 publications

(3 citation statements)

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“…Lactate levels may serve as a surrogate for disease severity and may be associated with a more pronounced coagulopathy at ECMO initiation. The correlation between high lactate levels upon ECMO initiation and ICH has previously been described by Grayck et al, who studied 82 neonatal ECMO patients and found higher lactate levels in neonates that developed ICH and In non-survivors 19 . High lactate levels compromise the coagulation system and if uncorrected, this impairment may contribute to ICH progression in ECMO patients 20 .…”

Section: Discussionsupporting

confidence: 52%

Predictors of intracranial hemorrhage in neonatal patients on extracorporeal membrane oxygenation

Wood,

Iacobelli,

Kopfer

et al. 2023

Sci Rep

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Extracorporeal membrane oxygenation (ECMO) is a life-supportive treatment in neonatal patients with refractory lung and/or heart failure. Intracranial hemorrhage (ICH) is a severe complication and reliable predictors are warranted. The aims of this study were to explore the incidence and possible predictors of ICH in ECMO-treated neonatal patients. We performed a single-center retrospective observational cohort study. Patients aged ≤ 28 days treated with ECMO between 2010 and 2018 were included. Exclusion criteria were ICH, ischemic stroke, cerebrovascular malformation before ECMO initiation or detected within 12 h of admission, ECMO treatment < 12 h, or prior treatment with ECMO at another facility > 12 h. The primary outcome was a CT-verified ICH. Logistic regression models were employed to identify possible predictors of the primary outcome. Of the 223 patients included, 29 (13%) developed an ICH during ECMO treatment. Thirty-day mortality was 59% in the ICH group and 16% in the non-ICH group (p < 0.0001). Lower gestational age (p < 0.01, odds ratio (OR) 0.96; 95%CI 0.94–0.98), and higher pre-ECMO lactate levels (p = 0.017, OR 1.1; 95%CI 1.01–1.18) were independently associated with increased risk of ICH-development. In the clinical setting, identification of risk factors and multimodal neuromonitoring could help initiate steps that lower the risk of ICH in these patients.

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Section: Discussionsupporting

confidence: 52%

Predictors of intracranial hemorrhage in neonatal patients on extracorporeal membrane oxygenation

Wood,

Iacobelli,

Kopfer

et al. 2023

Sci Rep

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“…Lactate accumulation has been observed in the brains of patients following ICH ( 15 ). Studies have explored the prognostic value of lactate in patients with ICH and illustrated that higher lactate levels are associated with 90-day mortality and poor outcomes in patients with ICH ( 16 , 17 ). Additionally, albumin, the most abundant protein in the plasma, is the main determinant of the balance of plasma oncotic pressure and the main modulator of fluid distribution between body compartments.…”

Section: Introductionmentioning

confidence: 99%

Association of lactate-to-albumin ratio with in-hospital and intensive care unit mortality in patients with intracerebral hemorrhage

Shen

Luo

2023

Front. Neurol.

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BackgroundIntracerebral hemorrhage (ICH) is a severe stroke subtype with a high mortality rate; the lactate-to-albumin ratio (LAR) is a new biomarker for predicting clinical outcomes in patients with ICH. However, the relationship between LAR and mortality in patients with ICH treated in the intensive care unit (ICU) remains controversial. Therefore, in this study, we aimed to investigate the association between LAR and in-hospital and ICU mortality in patients with ICH.MethodsPatients with ICH were selected from the Medical Information Mart for Intensive Care III (MIMIC-III) database; their clinical information, including baseline characteristics, vital signs, comorbidities, laboratory test results, and scoring systems, was extracted. Univariate and multivariate Cox proportional hazards analyses were used to investigate the association of LAR with in-hospital and ICU mortality. The maximum selection statistical method and subgroup analysis were used to investigate these relationships further. Kaplan–Meier (KM) analysis was used to draw survival curves.ResultsThis study enrolled 237 patients with ICH whose lactate and albumin levels, with median values of 1.975 and 3.6 mg/dl, respectively, were measured within the first 24 h after ICU admission. LAR had an association with increased risk of in-hospital mortality [unadjusted hazards ratio (HR), 1.79; 95% confidence interval (CI), 1.32–2.42; p < 0.001] and ICU mortality (unadjusted HR, 1.88; 95% CI, 1.38–2.55; p < 0.001). A cut-off value of 0.963 mg/dl was used to classify patients into high LAR (≥0.963) and low LAR (<0.963) groups, and survival curves suggested that those two groups had significant survival differences (p = 0.0058 and 0.0048, respectively). Furthermore, the high LAR group with ICH had a significantly increased risk of in-hospital and ICU mortality compared to the low LAR group.ConclusionOur study suggests that a high LAR is associated with an increased risk of in-hospital and ICU mortality in patients with ICH. Thus, the LAR is a useful prognostic predictor of clinical outcomes in patients with ICH.

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“…Elevated serum lactate levels have been correlated with rates of mortality (12). Studies that investigate the role of serum lactate in clinical entities such as shock, extracorporeal life support, myocardial infarction, and trauma (13,14) have shown a strong correlation between high blood lactate levels and an increased risk of morbidity and mortality. An absolute lactate level or range that correlates with morbidity or mortality has not been defined, although the peak lactate level may indicate low cardiac output or reduced tissue oxygen extraction.…”

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confidence: 99%

The Impact of Slow Rewarming on Inotropy, Tissue Metabolism, and “After Drop” of Body Temperature in Pediatric Patients

Saleh¹,

Barr²

2005

J Extra Corpor Technol

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Pediatric patients undergoing surgical correction of congenital heart diseases using cardiopulmonary bypass (CPB) are subjected to hypothermia. Core temperature is cooled down to 26–28°C during CPB. Postoperative hypothermia in these patients remains a source of long-intensive care unit (ICU) stay. Therefore, this study was performed to build a rewarming strategy aiming to improve the cardiac performance, minimize the early after-drop in both core and foot temperatures, and to achieve early achievement of homeostasis. Thirty pediatric patients of acyanotic congenital heart diseases were randomly allocated into one of three equal groups of 10. Group I was kept at 3°C between nasopharyngeal and heater-cooler unit water temperatures during rewarming whereas group II and group III were kept at 5°C and 7°C, respectively. The following parameters were measured: 1) cardiac performance (cardiac index and peak velocity); 2) cumulative amrinone consumption, blood lactate levels, and total body oxygen consumption; 3) intraoperative and postoperative peak and trough core and foot temperatures; and 4) time to extubation and ICU stay. Group I patients showed statistically significant increase in cardiac index and peak velocity compared with groups II and III, at p < 0.05 and p < 0.025, respectively. Statistically, the consumption of amrinone was significantly decreased in group I compared with groups II and III, with p < 0.005 and p < 0.0005, respectively, at 6 hours postoperatively. Group I showed an insignificant increase in blood lactate level, where groups II and III showed significant increases compared with controls (p < 0.001 at 6 hours postoperatively). Intraoperatively, both trough core and peak foot temperatures of group I patients statistically were significantly higher than in group III patients at p < 0.0005 and p < 0.05, respectively. The same applies in the ICU as regards to the time to core temperature (p < 0.005) and the rate of foot warming (p < 0.01). It was found that a difference of 3°C (group I) between nasopharyngeal and heater-cooler unit water temperatures during rewarming demonstrated the best outcome compared with 5°C and 7°C differences (groups II and III, respectively). This outcome was obvious in the following parameters: 1) the best cardiac performance (cardiac index and peak velocity); 2) the lowest values of cumulative amrinone consumption and blood lactate level; 3) the least after-drop in both core and foot temperatures; and 4) achievement of early homeostasis, shortest ICU stays, and conservation of the ICU resources.

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Elevated Serum Lactate Correlates With Intracranial Hemorrhage in Neonates Treated With Extracorporeal Life Support

Cited by 29 publications

References 0 publications

Predictors of intracranial hemorrhage in neonatal patients on extracorporeal membrane oxygenation

Predictors of intracranial hemorrhage in neonatal patients on extracorporeal membrane oxygenation

Association of lactate-to-albumin ratio with in-hospital and intensive care unit mortality in patients with intracerebral hemorrhage

The Impact of Slow Rewarming on Inotropy, Tissue Metabolism, and “After Drop” of Body Temperature in Pediatric Patients

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