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Cerebral Lactate Correlates with Early Onset Pneumonia after Aneurysmal SAH

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Abstract

Pneumonia is a significant medical complication following aneurysmal subarachnoid hemorrhage (aSAH). The aSAH may initiate immune interactions leading to depressed immunofunction, followed by an increased risk of infection. It remains unclear as to whether there is a possible association between cerebral metabolism and infections. Clinical and microdialysis data from aSAH patients prospectively included in the CoOperative Study on Brain Injury Depolarisations protocol Berlin were analyzed. Levels of glucose, lactate, pyruvate, and glutamate were measured hourly using microdialysis in the cerebral extracellular fluid. The occurrence of pneumonia (defined by positive microbiological cultures) and delayed ischemic neurological deficits (DIND) was documented prospectively. Eighteen aSAH patients (52.7 ± 10.7 years), classified according to the World Federation of Neurological Surgeons in low (I–III, n = 9) and high (IV–V, n = 9) grades, were studied. Eight patients (45 %) experienced DIND, 10 patients (56 %) pneumonia (mean onset day 2.6). Lactate was elevated at day 3 in infected patients (n = 9, median = 6.82 mmol/L) vs. patient without infections (n = 6, median = 2.90 mmol/L, p = 0.036). The optimum cut-off point to predict pneumonia at day 3 was 3.57 mmol/L with a sensitivity of 0.77, and a specificity of 0.66 (area under curve was 0.833 with p = 0.034). Lactate at day 7 was higher in DIND patients compared to no-DIND-patients (p = 0.016). Early elevated lactate correlated with occurrence of bacterial pneumonia, while late elevations with DIND after aSAH. Future investigations may elucidate the relationship between cerebral lactate and markers of immunocompetence and more detailed to identify patients with higher susceptibility for infections.

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Acknowledgments

This study is supported by grants from the Deutsche Forschungsgemeinschaft (DFG DR 323/5-1) and the Bundesministerium für Bildung und Forschung (Center for Stroke Research Berlin, 01 EO 0801; Bernstein Center for Computational Neuroscience Berlin 01GQ1001C B2) to Dr. Dreier.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Berlin, Germany

    S. Radolf, P. Vajkoczy & A. S. Sarrafzadeh

  2. Gippsland Medical School, Monash University, Melbourne, Australia

    N. Smoll

  3. Center for Stroke Research Berlin, Berlin, Germany

    C. Drenckhahn & J. P. Dreier

  4. Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    C. Drenckhahn & J. P. Dreier

  5. Departments of Experimental Neurology and Neurosurgery, Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    J. P. Dreier

  6. Division of Neurosurgery, Geneva University Hospitals, Geneva Neuroscience Center, Faculty of Medicine, University of Geneva, Geneva, Switzerland

    A. S. Sarrafzadeh

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  1. S. Radolf
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  2. N. Smoll
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  3. C. Drenckhahn
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  4. J. P. Dreier
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  5. P. Vajkoczy
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  6. A. S. Sarrafzadeh
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Correspondence to A. S. Sarrafzadeh.

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Radolf, S., Smoll, N., Drenckhahn, C. et al. Cerebral Lactate Correlates with Early Onset Pneumonia after Aneurysmal SAH. Transl. Stroke Res. 5, 278–285 (2014). https://doi.org/10.1007/s12975-013-0292-z

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  • DOI: https://doi.org/10.1007/s12975-013-0292-z

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