Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: A microdialysis study

Paul M. Vespa, David McArthur, Kristine H O'Phelan, Thomas Glenn, Maria Etchepare, Daniel Kelly, Marvin Bergsneider, Neil A. Martin, David A. Hovda

Research output: Contribution to journalArticle

242 Citations (Scopus)

Abstract

Disturbed glucose brain metabolism after brain trauma is reflected by changes in extracellular glucose levels. The authors hypothesized that posttraumatic reductions in extracellular glucose levels are not due to ischemia and are associated with poor outcome. Intracerebral microdialysis, electroencephalography, and measurements of brain tissue oxygen levels and jugular venous oxygen saturation were performed in 30 patients with traumatic brain injury. Levels of glucose, lactate, pyruvate, glutamate, and urea were analyzed hourly. The 6-month Glasgow Outcome Scale extended (GOSe6) score was assessed for each patient. In regions of increased glucose utilization defined by positron emission tomography, the extracellular glucose concentration was less than 0.2 mmol/1. Extra-cellular glucose values were less than 0.2 mmol during postinjury days 0 to 7 in 19% to 30% of hourly samples on each day. Transient decreases in glucose levels occurred with electrographic seizures and nonischemic reductions in cerebral perfusion pressure and jugular venous oxygen saturation. Glutamate levels were elevated in the majority of low-glucose samples, but the lactate/pyruvate ratio did not indicate focal ischemia. Terminal herniation resulted in reductions in glucose with increases in the lactate/pyruvate ratio but not in lactate concentration alone. GOSe6 scores correlated with persistently low glucose levels, combined early low glucose levels and low lactate/glucose ratio, and with the overall lactate/glucose ratio. These results suggest that the level of extracellular glucose is typically reduced after traumatic brain injury and associated with poor outcome, but is not associated with ischemia.

Original languageEnglish
Pages (from-to)865-877
Number of pages13
JournalJournal of Cerebral Blood Flow and Metabolism
Volume23
Issue number7
StatePublished - Jul 1 2003
Externally publishedYes

Fingerprint

Microdialysis
Lactic Acid
Glucose
Pyruvic Acid
Ischemia
Traumatic Brain Injury
Oxygen
Glutamic Acid
Cerebrovascular Circulation
Neck
Glasgow Outcome Scale
Brain
Positron-Emission Tomography
Urea
Electroencephalography

Keywords

  • Brain trauma
  • Glucose
  • Hyperglycolysis
  • Lactate
  • Microdialysis

ASJC Scopus subject areas

  • Endocrinology
  • Neuroscience(all)
  • Endocrinology, Diabetes and Metabolism

Cite this

Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate : A microdialysis study. / Vespa, Paul M.; McArthur, David; O'Phelan, Kristine H; Glenn, Thomas; Etchepare, Maria; Kelly, Daniel; Bergsneider, Marvin; Martin, Neil A.; Hovda, David A.

In: Journal of Cerebral Blood Flow and Metabolism, Vol. 23, No. 7, 01.07.2003, p. 865-877.

Research output: Contribution to journalArticle

Vespa, Paul M. ; McArthur, David ; O'Phelan, Kristine H ; Glenn, Thomas ; Etchepare, Maria ; Kelly, Daniel ; Bergsneider, Marvin ; Martin, Neil A. ; Hovda, David A. / Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate : A microdialysis study. In: Journal of Cerebral Blood Flow and Metabolism. 2003 ; Vol. 23, No. 7. pp. 865-877.
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