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. 2023 Mar 31;27(1):130.
doi: 10.1186/s13054-023-04409-6.

Cerebro-spinal fluid glucose and lactate concentrations changes in response to therapies in patIents with primary brain injury: the START-TRIP study

Elisa Gouvêa Bogossian  1 , Chahnez Taleb  2 , Raffaele Aspide  3 , Rafael Badenes  4 , Denise Battaglini  5   6 , Federico Bilotta  7 , Aaron Blandino Ortiz  8 , Anselmo Caricato  9 , Carlo Alberto Castioni  3 , Giuseppe Citerio  10 , Gioconda Ferraro  2 , Costanza Martino  11 , Isabella Melchionda  7 , Federica Montanaro  2 , Berta Monleon Lopez  4 , Consolato Gianluca Nato  7 , Michael Piagnerelli  12   13 , Edoardo Picetti  14 , Chiara Robba  5   6 , Olivier Simonet  15 , Aurelie Thooft  12 , Fabio Silvio Taccone  2
Affiliations

Cerebro-spinal fluid glucose and lactate concentrations changes in response to therapies in patIents with primary brain injury: the START-TRIP study

Elisa Gouvêa Bogossian et al. Crit Care. .

Abstract

Introduction: Altered levels of cerebrospinal fluid (CSF) glucose and lactate concentrations are associated with poor outcomes in acute brain injury patients. However, no data on changes in such metabolites consequently to therapeutic interventions are available. The aim of the study was to assess CSF glucose-to-lactate ratio (CGLR) changes related to therapies aimed at reducing intracranial pressure (ICP).

Methods: A multicentric prospective cohort study was conducted in 12 intensive care units (ICUs) from September 2017 to March 2022. Adult (> 18 years) patients admitted after an acute brain injury were included if an external ventricular drain (EVD) for intracranial pressure (ICP) monitoring was inserted within 24 h of admission. During the first 48-72 h from admission, CGLR was measured before and 2 h after any intervention aiming to reduce ICP ("intervention"). Patients with normal ICP were also sampled at the same time points and served as the "control" group.

Results: A total of 219 patients were included. In the intervention group (n = 115, 53%), ICP significantly decreased and CPP increased. After 2 h from the intervention, CGLR rose in both the intervention and control groups, although the magnitude was higher in the intervention than in the control group (20.2% vs 1.6%; p = 0.001). In a linear regression model adjusted for several confounders, therapies to manage ICP were independently associated with changes in CGLR. There was a weak inverse correlation between changes in ICP and CGRL in the intervention group.

Conclusions: In this study, CGLR significantly changed over time, regardless of the study group. However, these effects were more significant in those patients receiving interventions to reduce ICP.

Keywords: Acute brain injury; Cerebrospinal fluid; Glucose; Intracerebral hemorrhage; Intracranial pressure; Lactate; Subarachnoid hemorrhage; Traumatic brain injury.

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Conflict of interest statement

The authors declare that they have no competing interests regarding this manuscript.

Figures

Fig. 1
Fig. 1
Changes in the cerebral spinal fluid glucose, lactate and glucose-to-lactate ratio (CGLR) over time (baseline and 2 h after) in the control and the interventional group. P values represent the comparison between the trend over time of the control and intervention groups (time-group interaction); p values were calculated using a mixed model
Fig. 2
Fig. 2
Comparison of the changes in the cerebral spinal fluid glucose-to-lactate ratio (CGLR) over time in the control and different intervention subgroups. p values represent the comparison between trend over time of the two groups (time-group interaction) and were calculated using a mixed model
See this image and copyright information in PMC

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