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Cited by 296Traumatic Brain Injury and Neurovascular DisturbancesTraumatic Brain Injury ResearchTrauma and Emergency Care Studies

Energy dysfunction as a predictor of outcome after moderate or severe head injury: indices of oxygen, glucose, and lactate metabolism

Glenn, Thomas C, Kelly, Daniel F, Boscardin, W John, McArthur, David L, Vespa, Paul, Oertel, Matthias, Hovda, David A, Bergsneider, Marvin +2 more·2003·Journal of Cerebral Blood Flow & Metabolism
DOI 10.1097/01.wcb.0000089833.23606.7f
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Abstract

UNLABELLED: The purpose of this study was to determine if the relationship between abnormalities in glucose, lactate, and oxygen metabolism were predictive of neurologic outcome after moderate or severe head injury, relative to other known prognostic factors. Serial assessments of the cerebral metabolic rates for glucose, lactate, and oxygen were performed using a modified Kety-Schmidt method. In total, 31 normal control subjects were studied once, and 49 TBI patients (mean age 36+/-16 years, median GCS 7) were studied five times median per patient from postinjury days 0 to 9. Univariate and multivariate analyses were performed. Univariate analysis showed that the 6-month postinjury Glasgow Outcome Scale (GOS) was most strongly associated with the mean cerebral metabolic rate of oxygen (CMRO2) (P = 0.0001), mean arterial lactate level (P = 0.0001), mean arterial glucose (P = 0.0008), mean cerebral blood flow (CBF), (P = 0.002), postresuscitation GCS (P = 0.003), and pupillary status (P = 0.004). Brain lactate uptake was observed in 44% of all metabolic studies, and 76% of patients had at least one episode of brain lactate uptake. By dichotomized GOS, patients achieving a favorable outcome (GOS 4-5) were distinguished from those with an unfavorable outcome (GOS1-3) by having a higher CMRO2 (P = 0.003), a higher rate of abnormal brain lactate uptake relative to arterial lactate levels (P = 0.04), and lesser degrees of blood-brain barrier damage based on CT findings (P = 0.03). CONCLUSIONS: During the first 6 days after moderate or severe TBI, CMRO2 and arterial lactate levels are the strongest predictors of neurologic outcome. However, the frequent occurrence of abnormal brain lactate uptake despite only moderate elevations in arterial lactate levels in the favorable outcome patients suggests the brain's ability to use lactate as a fuel may be another key outcome predictor. Future studies are needed to determine to what degree nonglycolytic energy production from alternative fuels such as lactate occurs after TBI and whether alternative fuel administration is a viable therapy for TBI patients.

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Crossref · 10.1097/01.wcb.0000089833.23606.7f

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  • Cerebral ischemia and hypoxia lead to accumulation of lactic acid due to anaerobic glycolysis, increased permeability of membranes, and consecutive edema formation.

    “Because cerebral metabolic dysfunction occurs due to head trauma, cerebral ischemia and hypoxia lead to the accumulation of lactic acid due to anaerobic glycolysis, increased permeability of membranes, and consecutive edema formation (117, 118).”

    From Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach (2015) · cites this paper as [118]

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Authors
Glenn, T. C., Kelly, D. F., Boscardin, W. J., McArthur, D. L., Vespa, P., Oertel, M., Hovda, D. A., Bergsneider, M., Hillered, L., & Martin, N. A.
Affiliations
  • University of California, Los Angeles (US)
  • Uppsala University Hospital (SE)
Corresponding author
Kelly, Daniel F
ORCID
Venue
Journal of Cerebral Blood Flow & Metabolism
Publisher
SAGE Publications
Published
2003-10
Volume
23
Issue
10
Pages
1239-1250
ISSN
  • 0271-678X (ISSN-L)
  • 1559-7016
DOI
10.1097/01.wcb.0000089833.23606.7f
OpenAlex
W2028546276
Cited by
296
References
80
Citations by year
2026: 5 · 2025: 9 · 2024: 16 · 2023: 8 · 2022: 10 · 2021: 11 · 2020: 9 · 2019: 11 · 2018: 17 · 2017: 21 · 2016: 8 · 2015: 27 · 2014: 13 · 2013: 16 · 2012: 13
FWCI
5.85
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Cerebral Blood Flow & Metabolism (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute of Neurological Disorders and Stroke (P50NS030308, NS 30308)
Topics
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
Keywords
traumatic brain injury, brain energy metabolism, cerebral oxygen consumption, arterial lactate, brain glucose metabolism, prognostic factors, neurological outcome, Glasgow Outcome Scale, Kety-Schmidt method, cerebral blood flow, blood-brain barrier disruption, cerebral hypoxia
MeSH terms
Adult, Brain, Brain Injuries, Hypoxia, Brain, Cerebrovascular Circulation, Energy Metabolism, Female, Glucose, Glycolysis, Humans, Hypotension, Intracranial Pressure, Male, Middle Aged, Oxidative Phosphorylation, Oxygen, Predictive Value of Tests, Prognosis, Pupil Disorders, Cohort Studies, Glasgow Coma Scale, Multivariate Analysis, Lactic Acid

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