Association between the initial blood lactate level andprognosis in patients with stroke treated with intravenous thrombolysis

Aim: Decreased oxygen in cerebral tissues induces anaerobic glycolysis and lactate production increases. It has been demonstratedthat blood lactate level is an independent risk factor for poor outcome in patients with acute ischemic stroke (AIS). In this study, the association between initial blood lactate level and short-term prognosis in patients with AIS treated with intravenous thrombolysis was evaluated.Materials and Methods: Three hundred and sixty one patients treated with intravenous thrombolytic treatment (IVT) were includedin the study. Initial symptoms, comorbid diseases and localization of ischemia were recorded. Blood samples were obtained after stroke symptoms within 4.5 hours. Lactate levels were tested before IVT. Disability was calculated with National Institutes of Health Stroke Scale (NIHSS). At 24th and 72th hours, cerebral hemorrhagic transformation was evaluated with brain computed tomography. In-hospital mortality rate was determined. Patients were divided into 2 groups according to difference of NIHSS score (clinical improvement=NIHSS score decreased 4 points or more and no clinical improvement=other patients). Patients were divided into 2 groups according to lactate levels (low=lactate ≤2 mmol/L and high=lactate> 2 mmol/L).Results: A total of 361 patients, 188 (52.1%) female and 173 (47.9%) male were included in the study. Lactate level and base excess (BE) were higher in patients with severe disability (p

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1. Johnson CO, Nguyen M, Roth GA, et al. Global, regional, and national burden of stroke, 1990-2016: a
systematic analysis for the global burden of disease
study 2016. Lancet Neurol 2019;18:439-58.
2. Liu L, Wang D, Wong KS, et al. Stroke and stroke care in China: huge burden, significant workload, and a
national priority. Stroke 2011;42:3651-4.
3. PowersWJ, Rabinstein AA, Ackerson T, et al. 2018
guidelines for the early management of patients with
acute ischemic stroke: a guideline for healthcare
professionals from the American heart association/
American stroke association. Stroke 2018;49:46-110.
4. Cheripelli BK, Huang X, MacIsaac R, et al. Interaction
of recanalization, intracerebral hemorrhage, and
cerebral edema after intravenous thrombolysis.
Stroke 2016;47:1761-7.
5. Eren F, Ongun G, Yildogan AT, et al. Intravenous
thrombolytic therapy in acute ischemic stroke: Clinical
Evaluation. General Med J 2019;29:169-74.
6. Whiteley W, Chong WL, Sengupta A, et al. Blood
markers for the prognosis of ischemic stroke: a
systematic review. Stroke 2009;40:380-9.
7. Gundogdu OL, Bilge N, Yalcin A, et al. Association
between biomarkers in the long-term prognosis of
ischemic stroke. Ann Med Res 2019;26:1875-9.
8. Bruhn H, Frahm J, Gyngell ML, et al. Cerebral metabolism
in man after acute stroke: new observations using
localized proton NMR spectroscopy. Magn Reson
Med 1989;9:126-31.
9. Graham GD, Hwang JH, Rothman DL, et al.
Spectroscopic assessment of alterations in
macromolecule and small-molecule metabolites in
human brain after stroke. Stroke 2001;32:2797-802.
10. Berger C, Schabitz WR, Georgiadis D, et al. Effects
of hypothermia on excitatory amino acids and
metabolism in stroke patients: a microdialysis study.
Stroke 2002;33:519-24.
11. Schneweis S, Grond M, Staub F, et al. Predictive value
of neurochemical monitoring in large middle cerebral
artery infarction. Stroke 2001;32:1863-7.
12. Khosravani H, Shahpori R, Stelfox HT, et al. Occurrence
and adverse effect on outcome of hyperlactatemia in
the critically ill. Crit Care 2009;13:90.
13. Cerović O, Golubović V, Spec-Marn A, et al. Relationship
between injury severity and lactate levels in severely
injured patients. Intensive Care Med 2003;29:1300-5.
14. Nguyen HB, Rivers EP, Knoblich BP, et al. Early lactate
clearance is associated with improved outcome
in severe sepsis and septic shock. Crit Care Med
2004;32:1637-42.
15. Brouns R, Sheorajpanday R, Wauters A, et al. Evaluation
of lactate as a marker of metabolic stress and cause
of secondary damage in acute ischemic stroke or TIA.
Clin Chim Acta 2008;397:27-31.
16. Jo S, Jeong T, Lee JB, et al. Initial hyperlactatemia in
the ED is associated with poor outcome in patients
with ischemic stroke. Am J Emerg Med 2012;30:449-
55.
17. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018
guidelines for the early management of patients with
acute ischemic stroke: a guideline for healthcare
professionals from the American heart association/ American stroke association. Stroke 2018;49:46-110.
18. Adams HP Jr, Davis PH, Leira EC, et al. Baseline NIH stroke scale score strongly predicts outcome after
stroke: a report of the trial of org 10172 in acute stroke
treatment (TOAST). Neurology 1999;53:126-31.
19. Juneja D, Singh O, Dang R. Admission hyperlactatemia:
causes, incidence, and impact on outcome of patients
admitted in a general medical intensive care unit. J
Crit Care 2011;26:316-20.
20. Nichol AD, Egi M, Pettila V, et al. Relative
hyperlactatemia and hospital mortality in critically ill
patients: a retrospective multi-centre study. Crit Care
2010;14:25.
21. Groeneveld AB, Kester AD, Nauta JJ, et al. Relation
of arterial blood lactate to oxygen delivery and
hemodynamic variables in human shock states. Circ
Shock 1987;22:35-53.
22. Zymliński R, Biegus J, Sokolski M, et al. Increased
blood lactate is prevalent and identifies poor
prognosis in patients with acute heart failure without
overt peripheral hypoperfusion. Eur J Heart Fail
2018;20:1011-8.
23. Hajjar LA, Almeida JP, Fukushima JT, et al. High
lactate levels are predictors of major complications
after cardiac surgery. J Thorac Cardiovasc Surg
2013;146:455-60.
24. Wyss MT, Jolivet R, Buck A, et al. In vivo evidence
for lactate as a neuronal energy source. J Neurosci
2011;31:7477-85.
25. Parakh N, Gupta HL, Jain A. Evaluation of enzymes
in serum and cerebrospinal fluid in cases of stroke.
Neurol India 2002;50:518.
26. Berthet C, Lei H, Thevenet J, et al. Neuroprotective role
of lactate after cerebral ischemia. J Cereb Blood Flow
Metab 2009;29:1780-9.
27. Dohmen C, Bosche B, Graf R, et al. Identification
and clinical impact of impaired cerebrovascular
autoregulation in patients with malignant middle
cerebral artery infarction. Stroke 2007;38:56-61.
28. Oh TK, Song IA, Bae HJ, et al Serum lactate level upon
admission to the neuro-intensive care unit and 90-
day mortality: A retrospective study. J Clin Neurosci
2019;70:173-7.
29. Ganti L, Gilmore RM, Weaver AL, et al. Prognostic value
of complete blood count and electrolyte panel during
emergency department evaluation for acute ischemic
stroke. ISRN Stroke 2013