The Predictive Value Of Lactate Level On The Mortality In Children With Moderate To Sever Traumatic Brain Injury With Early Admission

BackgroundTraumatic brain injury is one of the most critical diseases,which is the common cause of children mortality and morbidity.Because of intracranial hematoma and encephaledema,the intracranial pressures elevated,automatic adjustment function of brain damaged,and the cerebral perfusion pressure declined,that introduced secondary cerebral ischemia and hypoxia,aggravatted the brain damages.Cerebral ischemia hypoxia can be detected and treated timely by monitoring cerebral oxygenation,which can alleviate the secondary brain damages after TBI,thereby improving outcome in these patients.Lactic acidosis is common in critical patients,blood lactate level can reflect the degree of hypoxia and tissue hypoperfusion.It is an important indicator of oxygen metabolism,Hyperlipidemia is closely related to the death of critically ill children.ObjectiveThe aim of this study is to explore the effect of early lactate level on the mortality in children with moderate to severe traumatic brain injury(TBI)and to explore the correlation between early lactate level and the critical score?GCS.Methods1.This retrospective cohort study was conducted in Critical Care Medicine,Children's Hospital of Chongqing Medical University between May 2011 and October 2014 included patients with moderate to severe traumatic brain injury [admission Glasgow Coma Scale(GCS)?13].2.The included patients were divided into death group and survival group.The clinical data regarding age,gender,body weight,the duration of hospital stays and laboratory index within 24 h afther admission(serum lactic acid,postassium,sodium,PLT count,PT,APTT,TT,FIB,D-Dimer)and so on,were collected.3.All of data was analyzed with SPSS21.0 statistics software.to perform univariate and multivariate analysis between death and survival groups.The receiver operation characteristic curve of serum lactic acid was used to dertermine the optimal cut-off value,and the corresponding sensitivity and specificity were calculated.To analyze the correlation between early lactate level and the critical score,GCS,coagulation.Result1.109 patients were enrolled.There were 92 survival and 17 deaths in hospital.2.The median lactate and the maximum lactate within 24 hours after admission of death group,combined the other organ injury ratio,the incidence of admission GCS?8and hypotension on admission were significantly higher than the survival group(4.90 vs.0.80mmo/L,5.00 vs.0.90mmol/L,76.47% vs.42.49%,94.12%vs.45.65%,76.47%vs.7.61%;all P< 0.05),the PT(18.20±5s vs.13.76±1.89s)?median APTT(36.90 vs.28.60s)?TT(26.41±8.18 s vs.19.05±2.60s)were significantly higher than the survival group.The median the duration of hospital stays,median FIB and the plasma potassium of death group were lower than survival group(2.00 vs.20.00 d,0.54 vs.1.40mg/L,3.38±0.52 vs.3.68±0.57mmol/L;all P< 0.05)?3.The ROC curve showed that lactate level could predict the mortality of pediatric patients with moderate to severe TBI(AUC 0.949,95% CI: 0.889 to 0.982,P< 0.001).The corresponding sensitivity and specificity of lactic acid cut-off value of 2.5mmol/L were 88.24% and 90.22%,respectively.4.Multivariate Logistic regression analysis showed that early lactic acid(OR=1.597;95%CI:1.064-2.399;P = 0.024)was the independent risk factors of death in moderate to severe TBI.However,GCS?8 on admission,other organ injury,and plasma potassium on admission and the critical score were not independent risk factors for death in this study.5.There is a negative relation between lactic acid and critical socre,neither nor GCS in children with moderate to sever traumatic brain injury.That means the higher lactic acid level is,the lower critical socre and GCS will be,indicating the more sever of the critical illness is.Conclusion1.The level of admission lactate can predict the death of children with moderate to severe traumatic brain injury.2.The elevated admission lactate is an independent risk factor for the mortality of children with moderate to severe traumatic brain injury.3.The level of admission lactate was correlated with critical score,GCS and coagulation,significantly,in chlidren with moderate to severe traumatic brain injury.