Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department

 My conclusion is totally different. Measure serum lactate immediately upon entry to the ER. Adjust levels as necessary. But I'm not medically trained so anything I say is useless.

Provide solutions you lazy fuckers. Telling next-of-kin that serum lactate levels are low and mortality is likely but you are doing nothing is going to be a fun conversation for you.

Serum Lactate Could Predict Mortality in Patients With Spontaneous Subarachnoid Hemorrhage in the Emergency Department

Chang Hwan Oh¹, Jong Won Kim^1,2*†, Geon Ha Kim^3*†, Kyeong Ryong Lee¹, Dae Young Hong¹, Sang O Park¹, Kwang Je Baek¹ and Sin Young Kim¹

• ¹Department of Emergency Medicine, Konkuk University Medical Center, School of Medicine, Konkuk University, Seoul, South Korea
• ²Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, South Korea
• ³Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University, Seoul, South Korea

Background: Serum lactate is a useful biomarker for prediction of mortality in critically ill patients. The purpose of this study was to identify if serum lactate could be used as a biomarker for predicting mortality in patients with subarachnoid hemorrhage (SAH) in the emergency department.

Methods: This retrospective study enrolled 189 patients. Baseline demographic data and clinical characteristics of patients were obtained from medical record review. Multiple logistic regression analysis was performed to determine predictor variables significantly associated with mortality. Receiver operating characteristic (ROC) curve analysis was used to evaluate the performance of variables for mortality prediction in SAH.

Results: Using multivariate logistic regression analysis, age [OR 1.05; 95% confidence interval (CI) 1.00–1.10; p = 0.037], Hunt and Hess scale score (OR 3.29; 95% CI 1.62–6.70; p = 0.001), serum lactate level (OR 1.33; 95% CI 1.03–1.74; p = 0.032), and serum glucose level (OR 1.01; 95% CI 1.00–1.02; p = 0.049) predicted overall mortality in SAH. The area under the ROC curve (AUC) value for the use of serum lactate level to predict mortality in SAH was 0.815 (95% CI 0.753–0.868) (p < 0.001).

Conclusion: Serum lactate may be a useful biomarker for the early prediction of mortality in SAH patients in the emergency department.

Introduction

A spontaneous subarachnoid hemorrhage (SAH) occurring secondary to a ruptured cerebral aneurysm is a devastating neurological disorder accounting for 5% of all stroke subtypes (1). About one-third of patients with this disorder die within a few days of initial bleeding, and most survivors have long-term neurological disability (2). Although surgical and medical advances have improved overall outcomes in these patients, SAH still remains a serious disease with a high mortality rate. Prediction of patient outcomes also remains challenging.

In the emergency department (ED), early and reliable prediction of outcomes for SAH can guide clinicians during treatment decision-making and can provide patients and their families with sufficient information about the disease. Prognostic determinations in patients with SAH are generally based on clinical and radiologic evaluations. The Hunt and Hess grading scale and the World Federation of Neurosurgical Societies grading scale are commonly used clinical tools for prediction of outcomes in these patients (3, 4). The modified Fisher grading scale is a radiology-based tool for predicting risks of clinical vasospasm and delayed cerebral ischemia, as well as patient outcomes (5). Recently, several biomarkers have been proposed as potential early predictors of disease prognosis in the ED. A reliable biomarker, in conjunction with clinical and radiologic scales, may be helpful for prognostic predictions in patients with SAH.

Serum lactate is a readily available biomarker in most EDs and has been shown to provide useful information about disease severity and mortality risk in critically ill patients (6). Moreover, its role in prognostic predictions for patients with sepsis and trauma has also been well-established (7, 8). However, comparatively little research has been devoted to the use of serum lactate in the management of patients with SAH. In this study, we hypothesized that serum lactate would be associated with outcomes in SAH patients, and we aimed to identify whether serum lactate could be used as a biomarker for predicting mortality in SAH patients in the ED.