Intrathecal lactate predicting hydrocephalus after aneurysmal subarachnoid hemorrhage

Kuo Chuan Wang, Sung Chun Tang, Jing Er Lee, Jiann Shing Jeng, Dar Ming Lai, Sheng Jean Huang, Sung Tsang Hsieh, Yong Kwang Tu

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH. Materials and methods Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed. Results There were 28 patients (mean age, 55.4 y; males, 46.6%), including 18 (64.3%) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P < 0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate >5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95% confidence interval: 3.8-270.8; P = 0.0015). Conclusions By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.

Original languageEnglish
Pages (from-to)523-528
Number of pages6
JournalJournal of Surgical Research
Volume199
Issue number2
DOIs
Publication statusPublished - Dec 1 2015
Externally publishedYes

Fingerprint

Subarachnoid Hemorrhage
Hydrocephalus
Lactic Acid
Cerebrospinal Fluid
Subarachnoid Space
Ferritins
Glucose
Drainage
Hemoglobins
Proteins
Odds Ratio
Confidence Intervals

Keywords

  • Cerebrospinal fluid
  • Hydrocephalus
  • Lactate
  • Shunting
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery

Cite this

Intrathecal lactate predicting hydrocephalus after aneurysmal subarachnoid hemorrhage. / Wang, Kuo Chuan; Tang, Sung Chun; Lee, Jing Er; Jeng, Jiann Shing; Lai, Dar Ming; Huang, Sheng Jean; Hsieh, Sung Tsang; Tu, Yong Kwang.

In: Journal of Surgical Research, Vol. 199, No. 2, 01.12.2015, p. 523-528.

Research output: Contribution to journalArticle

Wang, KC, Tang, SC, Lee, JE, Jeng, JS, Lai, DM, Huang, SJ, Hsieh, ST & Tu, YK 2015, 'Intrathecal lactate predicting hydrocephalus after aneurysmal subarachnoid hemorrhage', Journal of Surgical Research, vol. 199, no. 2, pp. 523-528. https://doi.org/10.1016/j.jss.2014.09.022
Wang, Kuo Chuan ; Tang, Sung Chun ; Lee, Jing Er ; Jeng, Jiann Shing ; Lai, Dar Ming ; Huang, Sheng Jean ; Hsieh, Sung Tsang ; Tu, Yong Kwang. / Intrathecal lactate predicting hydrocephalus after aneurysmal subarachnoid hemorrhage. In: Journal of Surgical Research. 2015 ; Vol. 199, No. 2. pp. 523-528.
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abstract = "Background Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH. Materials and methods Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed. Results There were 28 patients (mean age, 55.4 y; males, 46.6{\%}), including 18 (64.3{\%}) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P < 0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate >5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95{\%} confidence interval: 3.8-270.8; P = 0.0015). Conclusions By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.",
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AU - Wang, Kuo Chuan

AU - Tang, Sung Chun

AU - Lee, Jing Er

AU - Jeng, Jiann Shing

AU - Lai, Dar Ming

AU - Huang, Sheng Jean

AU - Hsieh, Sung Tsang

AU - Tu, Yong Kwang

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N2 - Background Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH. Materials and methods Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed. Results There were 28 patients (mean age, 55.4 y; males, 46.6%), including 18 (64.3%) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P < 0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate >5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95% confidence interval: 3.8-270.8; P = 0.0015). Conclusions By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.

AB - Background Evidence shows possible benefits from continuous drainage by lumbar drain after aneurysmal subarachnoid hemorrhage (SAH). Under the hypothesis that compartmentalization occurs between the ventricle and subarachnoid space after massive SAH, this study aimed to evaluate the biochemical differences between ventricular and intrathecal cerebrospinal fluid (CSF) and assess the role of CSF lactate in shunt-dependent hydrocephalus (SDHC) after aneurysmal SAH. Materials and methods Patients with modified Fisher grade III/IV aneurysmal SAH who underwent early obliteration were evaluated. Intrathecal and intraventricular CSF were obtained on day 7 post-SAH to measure their biochemical composition in terms of total protein, glucose, ferritin, and lactate. The associations of SDHC with the clinical parameters and CSF data were analyzed. Results There were 28 patients (mean age, 55.4 y; males, 46.6%), including 18 (64.3%) with SDHC. Intrathecal CSF had significantly higher levels of total protein, ferritin, hemoglobin, and lactate but lower glucose level than intraventricular CSF (all P < 0.0001). By multivariate analysis of clinical and CSF parameters, elevated intrathecal CSF lactate (P = 0.036) and the presence of intraventricular hemorrhage (P = 0.05) were independent factors associated with SDHC. Moreover, intrathecal lactate >5.5 μM effectively predicted the occurrence of SDHC (odds ratio: 32, 95% confidence interval: 3.8-270.8; P = 0.0015). Conclusions By compartmentalization of the subarachnoid space after SAH, intrathecal lactate level is a useful predictive parameter for long-term SDHC in patients with aneurysmal SAH patients.

KW - Cerebrospinal fluid

KW - Hydrocephalus

KW - Lactate

KW - Shunting

KW - Subarachnoid hemorrhage

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