| Objective: To study the value of CSF lactic acid levels and lactic acid levels in arterial blood and their clearance rates in the prognostic evaluation of aneurysmal subarachnoid hemorrhage.Methods: A total of 70 patients with aneurysmal subarachnoid hemorrhage admitted to the Department of Neurosurgery at the First Affiliated Hospital of Chengdu Medical College from october 2018 to december 2019 were selected as the study objects.The clinical data were collected such as the patient’s name,gender,age,education level,GCS score,Hunt-Hess grade,modified Fisher grade,past medical history(hypertension,diabetes),smoking history,surgical method,clinical complications and other clinical data.The cerebrospinal fluid and arterial blood samples of all patients included in the study were collected at three time points(0-24 hours,48-72 hours and 96-120 hours after operation)to test the lactate levels.Two variables-average lactic acid level and lactic acid clearance rate((the level of lactic acid 0-24 hours-the level of lactic acid within 48-72 hours)/ the level of lactic acid0-24 hours*100%)were included in the study and analysis.Patients included in the study were followed up in 3 months after operation,and the neurologic and cognitive statuses were evaluated respectively by mRS score and MMSE score.As for mRS score,the score of 0 to 2 indicates a favourable prognosis,and 3 to 6 indicates an unfavourable prognosis.According to MMSE scores,the patients were divided into normal group and abnormal group.In Part I,the mRS score was used as the outcome variable.Univariate analysis was used to compare the differences between the clinical data and biochemical indicators of the two groups of patients.Multivariate logistic regression analysis was used to screen for independent factors that affect the prognosis of patients.In Part II,the MMSE score was used as the outcome variable.Univariate analysis was used to compare the differences between the clinical data and biochemical indicators of the two groups of patients.Multivariate logistic regression analysis was used to screen for independent factors that affected patients’ cognition.Results:1.The trend of lactate level aSAH patients undergo increase of lactic acid levels in CSF and arterial blood with the CSF-LA levels rising in early stage and declining in middle and late stages.2.The mRS score was used as the outcome variable2.1 The results of univariate analysis:There was no significant difference between the two groups patient’s gender,hypertension history,diabetes history,smoking history,operation mode,CSF lactate level in 96-120 hours and arterial blood lactate level in 0-24 hours,lactic acid level in arterial blood in 48-72 hours and clearance rate of lactic acid in arterial blood in early stage(P>0.05).while they showed statistically significant difference between the two groups patient’s age,GCS score,Hunt-hess grade,modified Fisher grade,CSF lactic acid level at0-24 hours,CSF lactic acid level in 48-72 hours,average CSF lactic acid level,clearance rate of CSF lactic acid,lactic acid level in arterial blood in 96-120 hours and average lactic acid level in arterial blood(P<0.05).2.2 The results of multivariate logistic regression:(1)as for age: OR = 1.089,P=0.049(P<0.05)and 95% confidence interval(1.000,1.186),that is to say,for each additional year of age,the odds ratio of patients with mRS score 3 to 6 is 1.089.(2)as for GCS: OR=5.610,P=0.034(P<0.05)and 95% confidence interval,that is to say,for each additional level of GCS grade,the odds ratio of patients with mRS score 3 to 6 is5.610.(3)as for Hunt-hess grade: OR= 3.921,P=0.037(P<0.05)and 95% confidence interval,that is to say,for each additional level of Hunt-hess grade,the odds ratio of patients with mRS score 3 to 6 is 3.921.(4)clearance rate of CSF lactic acid: OR=9.821,P=0.028(P<0.05),that is to say,the odds ratio of patients with clearance rate of CSF lactic acid less than 10% and mRS score 3 to 6 to patients with clearance rate of CSF lactic acid equal to or higher than 10% and mRS score 3 to 6 is9.821.Research suggest that,based on the mRS score,the levels of cerebrospinal fluid and arterial blood lactate are not statistically significant.,and age,GCS score,Hunt-hess classification,cerebrospinal fluid lactate clearance are independent factors related to the prognosis of aSAH patients.3.the MMSE score was used as the outcome variable.3.1 The results of univariate analysis:There was no significant difference between the two groups patient’s gender,history of hypertension,history of diabetes,smoking history,surgical method,lactic acid level in arterial blood at 0-24 hours,CSF lactic acid level in 96-120 hours and clearance rate of lactic acid in arterial blood in early stage(P>0.05),while they showed statistically significant difference between the two groups patient’s age,GCS score,Hunt-hess grade,modified Fisher grade,CSF lactic acid level at 0-24 hours,CSF lactic acid level in 48-72 hours,average CSF lactic acid level,clearance rate of CSF lactic acid,lactic acid level in arterial blood in 48-72 hours and average lactic acid level in arterial blood(P<0.05).3.2 The results of multivariate logistic regression:(1)as for improved fisher grade:OR = 7.107,P<0.001 and 95% confidence interval(2.388,21.154),that is to say,for each additional level of Fisher grade,the odds ratio of patients having abnormal MMSE is 1.089.(2)as for clearance rate of CSF lactic acid: OR = 4.038,P=0.053(according to the significance level α=0.05,although the P value is at the borderline level of statistical significance,it is still considered as being statistically significant.),that is to say,the odds ratio of patients who have abnormal MMSE and whose clearance rate of CSF lactic acid is less than 10% to patients who have abnormal MMSE and whose clearance rate of CSF lactic acid is equal to or higher than 10%was 4.038.Research suggest that based on the MMSE score,the cerebrospinal fluid and arterial blood lactate levels are not statistically significant,and the modified Fisher classification and cerebrospinal fluid lactate clearance are independent factors related to the prognosis of aSAH patients.Conclusions:1.aSAH patients undergo increase of lactic acid levels in CSF and arterial blood with the CSF-LA levels rising in early stage and declining in middle and late stages.2.It is showed a bias using a single arterial blood or CSF lactic acid level as an indicator of prognosis of aSAH patients,and there is a good correlation between clearance rate of CSF lactic acid and prognosis evaluation indicators,which providesguidance in the judgment of patients’ prognosis. |
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