Serum Lactate Monitoring Predict Neurological Function Impairment Caused by Acute Metabolism Crisis

Abstract Objective: To investigate the predictive value of the serum lactate on neurological function impairment attributed to acute metabolism crisis (ACMC) .Methods: In this retrospective study, all the adult patients admitted to ICU more than 24h after general anesthesia elective neurosurgery from January 2018 to January 2019 were recruited. The data of the serum lactate every 8 h during the 24 h of ICU admission were acquired and analyzed.Results: 169 patients were included in the outcomes analysis. The average serum lactate after ICU admission was (3.7(0.7), mmol/L), higher than normal, suggesting that ACMC commonly existed. The serum lactate at ICU admission (lactateserum0h) was not correlated with the outcomes,but the predictive value increased with the extension of the monitoring time. The lactateserum8h, the lactateserum16h and the lactateserum24h were found to be associated with the primary outcome(difference of GCS scores before the surgery and after 24 h of ICU admission (ΔGCS24h)(p<0.05). The lactateserum16h and the lactateserum 24h were associated with all the outcomes except the hospital LOS. The ROC curve revealed that the lactateserum24h had the best predictive value. The graph of the dynamic changes of the serum lactate indicated that patients with serum lactate non-recovered trend after 24 h of ICU stay had decreased GCS scores, and vice versa. To find an index predicting ACMC earlier, the predictive value of the serum glucose/serum lactate ratio at ICU admission (G/Lserum) was analyzed and found to be associated with the ΔGCS24h(p<0.05), the G/Lserum can predict the ACMC earlier.Conclusions: Dynamic serum lactate monitoring and the G/Lserum at ICU admission have predictive value on neurological function impairment attributed to ACMC.