Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury
OBJECTIVE:To determine whether persistent metabolic dysfunction in normal-appearing frontal lobe tissue is correlated with long-term tissue atrophy. DESIGN:Prospective monitoring with retrospective data analysis. SETTING:Single-center academic neurointensive care unit. PATIENTS:Fifteen patients with...
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| Veröffentlicht in: | Critical care medicine 2008-10, Vol.36 (10), p.2871-2877 |
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| creator | Marcoux, Judith McArthur, David A Miller, Chad Glenn, Thomas C Villablanca, Pablo Martin, Neil A Hovda, David A Alger, Jeffry R Vespa, Paul M |
| description | OBJECTIVE:To determine whether persistent metabolic dysfunction in normal-appearing frontal lobe tissue is correlated with long-term tissue atrophy.
DESIGN:Prospective monitoring with retrospective data analysis.
SETTING:Single-center academic neurointensive care unit.
PATIENTS:Fifteen patients with moderate to severe traumatic brain injury (Glasgow Coma Scale score 3–12).
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Hourly cerebral microdialysis was performed for the initial 96 hrs after trauma to determine extracellular levels of glucose, glutamate, glycerol, lactate, and pyruvate in normal appearing frontal lobes. Six months after injury, the anatomical outcome was assessed by measures of global and regional cerebral atrophy using volumetric brain magnetic resonance imaging. The lactate/pyruvate ratio was elevated >40 after traumatic brain injury in most patients, with a mean percent time of 32 ± 29% of hours monitored. At 6 months after traumatic brain injury, there was a mean frontal lobe atrophy of 12 ± 11% and global brain atrophy of 8.5 ± 4.5%. The percentage of time of elevated lactate/pyruvate ratio correlated with the extent of frontal lobe brain atrophy (r = −.56, p < 0.01), but not global brain atrophy (r = −.31, p = 0.20). The predictive effect of lactate/pyruvate ratio was independent of patient age, Glasgow Coma Scale score, and volume of frontal lobe contusion.
CONCLUSION:Persistent metabolic crisis, as reflected by an elevated lactate/pyruvate ratio, in normal appearing posttraumatic frontal lobe, is predictive of the degree of tissue atrophy at 6 months. |
| doi_str_mv | 10.1097/CCM.0b013e318186a4a0 |
| format | Article |
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DESIGN:Prospective monitoring with retrospective data analysis.
SETTING:Single-center academic neurointensive care unit.
PATIENTS:Fifteen patients with moderate to severe traumatic brain injury (Glasgow Coma Scale score 3–12).
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Hourly cerebral microdialysis was performed for the initial 96 hrs after trauma to determine extracellular levels of glucose, glutamate, glycerol, lactate, and pyruvate in normal appearing frontal lobes. Six months after injury, the anatomical outcome was assessed by measures of global and regional cerebral atrophy using volumetric brain magnetic resonance imaging. The lactate/pyruvate ratio was elevated >40 after traumatic brain injury in most patients, with a mean percent time of 32 ± 29% of hours monitored. At 6 months after traumatic brain injury, there was a mean frontal lobe atrophy of 12 ± 11% and global brain atrophy of 8.5 ± 4.5%. The percentage of time of elevated lactate/pyruvate ratio correlated with the extent of frontal lobe brain atrophy (r = −.56, p < 0.01), but not global brain atrophy (r = −.31, p = 0.20). The predictive effect of lactate/pyruvate ratio was independent of patient age, Glasgow Coma Scale score, and volume of frontal lobe contusion.
CONCLUSION:Persistent metabolic crisis, as reflected by an elevated lactate/pyruvate ratio, in normal appearing posttraumatic frontal lobe, is predictive of the degree of tissue atrophy at 6 months.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/CCM.0b013e318186a4a0</identifier><identifier>PMID: 18766106</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Adolescent ; Adult ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Atrophy - etiology ; Atrophy - pathology ; Biological and medical sciences ; Biomarkers - analysis ; Brain Diseases - etiology ; Brain Diseases - pathology ; Brain Injuries - complications ; Brain Injuries - diagnosis ; Brain Injuries - therapy ; Chronic Disease ; Cohort Studies ; Critical Illness - mortality ; Critical Illness - therapy ; Female ; Follow-Up Studies ; Frontal Lobe - pathology ; Glasgow Coma Scale ; Humans ; Injuries of the nervous system and the skull. Diseases due to physical agents ; Injury Severity Score ; Intensive care medicine ; Intensive Care Units ; Lactic Acid - analysis ; Male ; Medical sciences ; Microdialysis - methods ; Middle Aged ; Predictive Value of Tests ; Pyruvic Acid - analysis ; Retrospective Studies ; Risk Assessment ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Traumas. Diseases due to physical agents</subject><ispartof>Critical care medicine, 2008-10, Vol.36 (10), p.2871-2877</ispartof><rights>2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3803-eca1dfdcf3bd2c4958f0a9c06f657f0b6eaa1642383e1240f433a0eb34556cbc3</citedby><cites>FETCH-LOGICAL-c3803-eca1dfdcf3bd2c4958f0a9c06f657f0b6eaa1642383e1240f433a0eb34556cbc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20714944$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18766106$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marcoux, Judith</creatorcontrib><creatorcontrib>McArthur, David A</creatorcontrib><creatorcontrib>Miller, Chad</creatorcontrib><creatorcontrib>Glenn, Thomas C</creatorcontrib><creatorcontrib>Villablanca, Pablo</creatorcontrib><creatorcontrib>Martin, Neil A</creatorcontrib><creatorcontrib>Hovda, David A</creatorcontrib><creatorcontrib>Alger, Jeffry R</creatorcontrib><creatorcontrib>Vespa, Paul M</creatorcontrib><title>Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:To determine whether persistent metabolic dysfunction in normal-appearing frontal lobe tissue is correlated with long-term tissue atrophy.
DESIGN:Prospective monitoring with retrospective data analysis.
SETTING:Single-center academic neurointensive care unit.
PATIENTS:Fifteen patients with moderate to severe traumatic brain injury (Glasgow Coma Scale score 3–12).
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Hourly cerebral microdialysis was performed for the initial 96 hrs after trauma to determine extracellular levels of glucose, glutamate, glycerol, lactate, and pyruvate in normal appearing frontal lobes. Six months after injury, the anatomical outcome was assessed by measures of global and regional cerebral atrophy using volumetric brain magnetic resonance imaging. The lactate/pyruvate ratio was elevated >40 after traumatic brain injury in most patients, with a mean percent time of 32 ± 29% of hours monitored. At 6 months after traumatic brain injury, there was a mean frontal lobe atrophy of 12 ± 11% and global brain atrophy of 8.5 ± 4.5%. The percentage of time of elevated lactate/pyruvate ratio correlated with the extent of frontal lobe brain atrophy (r = −.56, p < 0.01), but not global brain atrophy (r = −.31, p = 0.20). The predictive effect of lactate/pyruvate ratio was independent of patient age, Glasgow Coma Scale score, and volume of frontal lobe contusion.
CONCLUSION:Persistent metabolic crisis, as reflected by an elevated lactate/pyruvate ratio, in normal appearing posttraumatic frontal lobe, is predictive of the degree of tissue atrophy at 6 months.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Atrophy - etiology</subject><subject>Atrophy - pathology</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - analysis</subject><subject>Brain Diseases - etiology</subject><subject>Brain Diseases - pathology</subject><subject>Brain Injuries - complications</subject><subject>Brain Injuries - diagnosis</subject><subject>Brain Injuries - therapy</subject><subject>Chronic Disease</subject><subject>Cohort Studies</subject><subject>Critical Illness - mortality</subject><subject>Critical Illness - therapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Frontal Lobe - pathology</subject><subject>Glasgow Coma Scale</subject><subject>Humans</subject><subject>Injuries of the nervous system and the skull. Diseases due to physical agents</subject><subject>Injury Severity Score</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Lactic Acid - analysis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microdialysis - methods</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Pyruvic Acid - analysis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed</subject><subject>Traumas. Diseases due to physical agents</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkd2K1TAUhYsoznH0DURyo3cdd5o0bS_l4M_AiF7oddlJdzgZ0x-TdIa-kk9pDlMcMBCS7P2tFdirKF5zuOLQNe-Px69XoIELErzlrUKJ8KQ48FpACVUnnhYHgA5KITtxUbyI8RaAy7oRz4sL3jZKcVCH4s93CtHFRFNiIyXUs3eGmeBykWHMNYxroIHpjZGnO0z5biiQDujZ6EyYB4d-O-MeTcr9ctnCegZZwORmtmS5MykycwrzlN1tPlJW-1kTyz5uYpjCvJw2hjZRYCngOmat2btuul3D9rJ4ZtFHerWfl8XPTx9_HL-UN98-Xx8_3JRGtCBKMsgHOxgr9FAZ2dWtBewMKKvqxoJWhMiVrEQriFcSrBQCgbSQda2MNuKyePfgu4T590ox9aOLhrzHieY19qpTXLSyyaB8APMQYgxk-yW4EcPWc-jPGfU5o_7_jLLsze6_6pGGR9EeSgbe7gBGg94GnIyL_7gKGi47KR__v599Hlv85dd7Cv2J0KdTD3mJSqqyAmj5-VXmXQnxF3FnsEA</recordid><startdate>200810</startdate><enddate>200810</enddate><creator>Marcoux, Judith</creator><creator>McArthur, David A</creator><creator>Miller, Chad</creator><creator>Glenn, Thomas C</creator><creator>Villablanca, Pablo</creator><creator>Martin, Neil A</creator><creator>Hovda, David A</creator><creator>Alger, Jeffry R</creator><creator>Vespa, Paul M</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200810</creationdate><title>Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury</title><author>Marcoux, Judith ; McArthur, David A ; Miller, Chad ; Glenn, Thomas C ; Villablanca, Pablo ; Martin, Neil A ; Hovda, David A ; Alger, Jeffry R ; Vespa, Paul M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3803-eca1dfdcf3bd2c4958f0a9c06f657f0b6eaa1642383e1240f433a0eb34556cbc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Atrophy - etiology</topic><topic>Atrophy - pathology</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - analysis</topic><topic>Brain Diseases - etiology</topic><topic>Brain Diseases - pathology</topic><topic>Brain Injuries - complications</topic><topic>Brain Injuries - diagnosis</topic><topic>Brain Injuries - therapy</topic><topic>Chronic Disease</topic><topic>Cohort Studies</topic><topic>Critical Illness - mortality</topic><topic>Critical Illness - therapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Frontal Lobe - pathology</topic><topic>Glasgow Coma Scale</topic><topic>Humans</topic><topic>Injuries of the nervous system and the skull. Diseases due to physical agents</topic><topic>Injury Severity Score</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Lactic Acid - analysis</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microdialysis - methods</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Pyruvic Acid - analysis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed</topic><topic>Traumas. Diseases due to physical agents</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marcoux, Judith</creatorcontrib><creatorcontrib>McArthur, David A</creatorcontrib><creatorcontrib>Miller, Chad</creatorcontrib><creatorcontrib>Glenn, Thomas C</creatorcontrib><creatorcontrib>Villablanca, Pablo</creatorcontrib><creatorcontrib>Martin, Neil A</creatorcontrib><creatorcontrib>Hovda, David A</creatorcontrib><creatorcontrib>Alger, Jeffry R</creatorcontrib><creatorcontrib>Vespa, Paul M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marcoux, Judith</au><au>McArthur, David A</au><au>Miller, Chad</au><au>Glenn, Thomas C</au><au>Villablanca, Pablo</au><au>Martin, Neil A</au><au>Hovda, David A</au><au>Alger, Jeffry R</au><au>Vespa, Paul M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2008-10</date><risdate>2008</risdate><volume>36</volume><issue>10</issue><spage>2871</spage><epage>2877</epage><pages>2871-2877</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:To determine whether persistent metabolic dysfunction in normal-appearing frontal lobe tissue is correlated with long-term tissue atrophy.
DESIGN:Prospective monitoring with retrospective data analysis.
SETTING:Single-center academic neurointensive care unit.
PATIENTS:Fifteen patients with moderate to severe traumatic brain injury (Glasgow Coma Scale score 3–12).
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Hourly cerebral microdialysis was performed for the initial 96 hrs after trauma to determine extracellular levels of glucose, glutamate, glycerol, lactate, and pyruvate in normal appearing frontal lobes. Six months after injury, the anatomical outcome was assessed by measures of global and regional cerebral atrophy using volumetric brain magnetic resonance imaging. The lactate/pyruvate ratio was elevated >40 after traumatic brain injury in most patients, with a mean percent time of 32 ± 29% of hours monitored. At 6 months after traumatic brain injury, there was a mean frontal lobe atrophy of 12 ± 11% and global brain atrophy of 8.5 ± 4.5%. The percentage of time of elevated lactate/pyruvate ratio correlated with the extent of frontal lobe brain atrophy (r = −.56, p < 0.01), but not global brain atrophy (r = −.31, p = 0.20). The predictive effect of lactate/pyruvate ratio was independent of patient age, Glasgow Coma Scale score, and volume of frontal lobe contusion.
CONCLUSION:Persistent metabolic crisis, as reflected by an elevated lactate/pyruvate ratio, in normal appearing posttraumatic frontal lobe, is predictive of the degree of tissue atrophy at 6 months.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>18766106</pmid><doi>10.1097/CCM.0b013e318186a4a0</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Atrophy - etiology Atrophy - pathology Biological and medical sciences Biomarkers - analysis Brain Diseases - etiology Brain Diseases - pathology Brain Injuries - complications Brain Injuries - diagnosis Brain Injuries - therapy Chronic Disease Cohort Studies Critical Illness - mortality Critical Illness - therapy Female Follow-Up Studies Frontal Lobe - pathology Glasgow Coma Scale Humans Injuries of the nervous system and the skull. Diseases due to physical agents Injury Severity Score Intensive care medicine Intensive Care Units Lactic Acid - analysis Male Medical sciences Microdialysis - methods Middle Aged Predictive Value of Tests Pyruvic Acid - analysis Retrospective Studies Risk Assessment Sensitivity and Specificity Tomography, X-Ray Computed Traumas. Diseases due to physical agents |
| title | Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury |
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