Comparison of Blood Lactate Concentrations in Patients with Closed Traumatic Brain Injuries after Surgical and Conservative Interventions

Topan Sugara Kiaydemak; Willy Adhimarta; Nasrullah Nasrullah; Andi Ihwan; Mulawardi Mulawardi; Andi Alfian Zainuddin; Prihantono Prihantono; Djoko Widodo; Andi Asadul Islam; Muhammad Faruk

doi:10.3889/oamjms.2022.11137

Authors

Topan Sugara Kiaydemak Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia; 2Department of Surgery, Dr. Chasan Boesoirie General Hospital, Ternate, Indonesia https://orcid.org/0000-0003-3426-6280
Willy Adhimarta Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Nasrullah Nasrullah Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Andi Ihwan Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Mulawardi Mulawardi Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Andi Alfian Zainuddin Department of Public Health and Community Medicine Science, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Prihantono Prihantono Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Djoko Widodo Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Andi Asadul Islam Department of Neurosurgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Muhammad Faruk Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia https://orcid.org/0000-0002-7079-4585

DOI:

https://doi.org/10.3889/oamjms.2022.11137

Keywords:

Closed brain injury, Lactate concentration, Surgical intervention, Conservative treatment, Epidural hematoma

Abstract

Introduction: A major public health problem, brain injury can cause disability and death. Managing traumatic brain injury (TBI) can involve surgical interventions (e.g., evacuation and decompressive craniotomy) and/or conservative interventions without surgery (e.g., oxygenation, resuscitation, antibiotics, osmotherapy, and analgesics). Lactate, a biomarker that exerts physiological effects, is sensitive to the lack of oxygen and ischemia in organs such as the brain in both types of interventions. The aim of our study was thus to compare lactate concentrations in patients with closed brain injuries after conservative and surgical interventions.

Methods: In a cohort study, lactate concentration between patients with TBI in the conservative versus surgical intervention groups were analyzed using the chi-square test, the independent t test, and Spearman’s correlation test.

Results: Lactate concentrations in patients with closed brain injuries at the baseline, 24-hour, and 72-hour blood sampling time points did not significantly differ between conservative and surgical interventions (ρ > 0.05). However, reductions in lactate concentrations after 24 and 72 hours did significantly differ between the intervention groups, despite being more reduced in surgical interventions (ρ = 0.001) than in conservative ones (ρ = 0.002). Lactate concentrations were also significantly lower after 24 and 72 hours in the surgical intervention group for patients with epidural hematoma (EDH, p= 0.001) than ones without EDH (ρ < 0.001).

Conclusion: Lactate concentration is a reliable prognostic predictor for assessing the severity of brain injury other than the GCS, another common clinical predictor.

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