Correlation of Levels of Lactic Acid and Glucose in Cerebrospinal Fluid of Cerebral Hemorrhage Patients with the Occurrence of Postoperative Intracranial Infection and Clinical Prognosis

Lactic Acid and Glucose Correlation in Hemorrhage Patients

  • Lei Zhang
  • Yan Zhang
  • Xiaotian Wang
  • Yun Zhao Administration Department of Nosocomial Infection Dongying People's Hospital
Keywords: cerebral hemorrhage, lactic acid, glucose, postoperative intracranial infection, clinical prognosis, correlation

Abstract


Background: To analyze the correlation of the levels of lactic acid and glucose in cerebrospinal fluid (CSF) of cerebral hemorrhage patients with the postoperative intracranial infection and clinical prognosis.

Methods: The study selected the clinical data of 324 patients with cerebral hemorrhage who underwent surgical treatment in our hospital from March 2020 to March 2022 for retrospective analysis, and divided these patients into the intracranial infection group (Group A, n=22, leukocyte values in CSF>5×106/L) and the non-intracranial infection group (Group B, n=302, leukocyte values in CSF≤5×106/L) according to the occurrence of postoperative intracranial infection in patients to detect the levels of lactic acid and glucose in CSF at different times in the two groups. Pearson method was adopted to analyze the correlation of the levels of lactic acid and glucose in CSF of patients with intracranial infection, and the Glasgow Outcome Scale (GOS) was used to assess the clinical prognosis of patients. According to their scores, these patients were divided into two groups, namely, the good prognosis group (GPG, scores of 4-5 points, n=178) and the poor prognosis group (PPG, scores of 1-3 points, n=146). The levels of lactic acid and glucose in CSF of patients in the two groups were measured, and Pearson method was adopted to analyze the the relationship between these levels and clinical prognosis.

Results: Compared with the Group B, the Group A had markedly higher lactic acid levels in CSF of patients at T1, T2 and T3 (P<0.001), and notably lower glucose levels (P<0.001). Patients in the PPG had notably higher lactic acid levels in CSF at T1, T2 and T3 (P<0.001) and overtly lower glucose levels than those in the GPG (P<0.001). The results of Pearson showed that lactic acid levels in CSF of patients were positively correlated with leukocyte values, but negatively correlated with glucose levels (P<0.05). The lactic acid levels in CSF were negatively correlated with GOS scores, but positively correlated with glucose levels (P<0.05).

Conclusion: The levels of lactic acid and glucose in CSF of patients with cerebral hemorrhage are correlated with postoperative intracranial infection and clinical prognosis, and the detection of the above indicators will help doctors better understand patients’ condition, thus providing scientific basis for the formulation of clinical treatment plans.

References

1.        Magid-Bernstein J, Girard R, Polster S, Srinath A, Romanos S, Awad IA, et al. Cerebral Hemorrhage: Pathophysiology, Treatment, and Future Directions. Circ Res 2022; 130(8): 1204-29.


2.        Powers WJ. Strokelore: Intracranial volumes and pressures following cerebral hemorrhage. J Stroke Cerebrovasc 2022; 31(9): 106637.


3.        Ruan L, Wu D, Li X, Huang Q, Lin L, Lin J, et al. Analysis of microbial community composition and diversity in postoperative  intracranial infection using highthroughput sequencing. Mol Med Rep 2017; 16(4): 3938-46.


4.        McClelland SR. Postoperative intracranial neurosurgery infection rates in North America versus Europe: a systematic analysis. Am J Infect Control 2008; 36(8): 570-3.


5.        Hristeva L, Bowler I, Booy R, King A, Wilkinson AR. Value of cerebrospinal fluid examination in the diagnosis of meningitis in the newborn. Arch Dis Child 1993; 69(5 Spec No): 514-7.


6.        Cunha BA. Cerebrospinal fluid lactic acid levels: accurate, fast, and inexpensive. Crit Care Med 2011; 39(10): 2383-4, 2384-5.


7.        Annoni F, Peluso L, Gouvea BE, Creteur J, Zanier ER, Taccone FS. Brain Protection after Anoxic Brain Injury: Is Lactate Supplementation Helpful? Cells-Basel 2021; 10(7): 1714.


8.        Sanjith S, S MK, G TP, M SS. Correlation between CSF Glucose Estimation using Glucometers against the Conventional Laboratory Technique in Determining Bacterial Meningitis: An Indian Study. J Assoc Physicians India 2020; 68(2): 43-7.


9.        Yin L, Han Y, Miao G, Jiang L, Xie S, Liu B. CSF leukocyte, polykaryocyte, protein and glucose: Their cut-offs of judging whether post-neurosurgical bacterial meningitis has been cured. Clin Neurol Neurosur 2018; 174: 198-202.


10.    World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama-J Am Med Assoc 2013; 310(20): 2191-4.


11.    Cao Y, Yu S, Zhang Q, Yu T, Liu Y, Sun Z, et al. Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of intracerebral haemorrhage. Stroke Vasc Neurol 2020; 5(4): 396-402.


12.    An Z, Yin Y, Zhang L, Wang B, Cui T, Li M, et al. Effect of Ulinastatin Combined with Xingnaojing Injection on Severe Traumatic Craniocerebral Injury and Its Influence on Oxidative Stress Response and Inflammatory Response. Biomed Res Int 2022; 2022: 2621732.


13.    Tian Y, Du HG, Fan CP, Wang C, Zhang GJ, Chen L, et al. Clinical significance of percutaneous endoscopic gastrostomy for patients with severe craniocerebral injury. Chin J Traumatol 2014; 17(6): 341-4.


14.    Kim YJ, Moon KS, Kim SK, Kang SJ, Lee KH, Jang WY, et al. The difference in diffusion-weighted imaging with apparent diffusion coefficient between spontaneous and postoperative intracranial infection. Brit J Neurosurg 2014; 28(6): 765-70.


15.    Berndt M, Lange N, Ryang YM, Meyer B, Zimmer C, Hapfelmeier A, et al. Value of Diffusion-Weighted Imaging in the Diagnosis of Postoperative Intracranial Infections. World Neurosurg 2018; 118: e245-53.


16.    Aguirre M, Collins MD. Lactic acid bacteria and human clinical infection. J Appl Bacteriol 1993; 75(2): 95-107.


17.    Kolling GL, Wu M, Warren CA, Durmaz E, Klaenhammer TR, Timko MP, et al. Lactic acid production by Streptococcus thermophilus alters Clostridium difficile infection and in vitro Toxin A production. Gut Microbes 2012; 3(6): 523-9.


18.    Boer K, Pfister W, Kiehntopf M. Lactic acid is of low predictive value for the diagnosis of bacterial infection in ventricular cerebrospinal fluid samples containing residual blood. Clin Chem Lab Med 2010; 48(12): 1777-80.


19.    Valente DSL, Hoffmann A, Weiss G. Impact of bacterial infections on erythropoiesis. Expert Rev Anti-Infe 2021; 19(5): 619-33.


20.    WROBLEWSKI F, LADUE JS. Lactic dehydrogenase activity in blood. Proc Soc Exp Biol Med 1955; 90(1): 210-3.


21.    Zhang W, Wang G, Xu ZG, Tu H, Hu F, Dai J, et al. Lactate Is a Natural Suppressor of RLR Signaling by Targeting MAVS. Cell 2019; 178(1): 176-89.


22.    Tang BL. Glucose, glycolysis, and neurodegenerative diseases. J Cell Physiol 2020; 235(11): 7653-62.


23.    Lopez-Gambero AJ, Martinez F, Salazar K, Cifuentes M, Nualart F. Brain Glucose-Sensing Mechanism and Energy Homeostasis. Mol Neurobiol 2019; 56(2): 769-96.


24.    Yin W, Weng S, Lai S, Nie H. [GCS score combined with CT score and serum S100B protein level Can evaluate severity and early prognosis of acute traumatic brain injury]. Nan Fang Yi Ke Da Xue Xue Bao 2021; 41(4): 543-8.

Published
2023/06/23
Section
Original paper