Article
Postoperative elevated serum lactate levels after intracranial tumour surgery is independent from tumour histology and determined by steroid administration and surgery length
Postoperativ erhöhte Serumlaktatspiegel nach intrakraniellen Tumoroperationen sind unabhängig von der Tumorhistologie und werden durch die Steroidverabreichung und die Operationsdauer bestimmt
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Authors
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Malte Mohme
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Jennifer Göttsche
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Nils Schweingruber
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurologie, Hamburg, Deutschland
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Jörn Grensemann
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
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Jan Regelsberger
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Manfred Westphal
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
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Patrick Czorlich
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Neurochirurgie, Hamburg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: The aim of this study is to evaluate factors impacting postoperative elevated serum lactate levels after intracranial tumor removal. We hypothesized that tumor histology, together with intraoperative factors, such as steroid administration or surgery length are the major determinants for postoperative elevated serum lactate levels.
Methods: In total, we included 674 intracranially resected patients in this study. Tumor histology included glioblastoma (IDHwt, n = 284), astrocytoma (IDHmut, n = 184), 142 oligodendroglioma (n = 142), and meningioma (n = 100). Basic parameters, such as gender, age, tumor location, Ki67 index, WHO grade, surgery lengths, pre- and perioperative dexamethasone administration, as well as 17 postoperative metabolic and basic blood parameters on intensive care unit were analyze using a LMER and a linear statistic approach. Patients were subsequentially stratified into high (>2mg/dl lactate) and low postoperative serum lactate level groups to analyze individual risk factors.
Results: Multivariate analysis showed that different tumor histologies did not correlate with an increase prevalence of postoperative elevated serum lactate levels. Increased serum lactate levels in the early postoperative course were primarily associated with surgery lengths and pre-/intraoperative steroid administration (p < 0.001). Lactate levels peaked at 12 hours and remained elevated within the first 24h postoperatively. The lab parameter profile of patients with elevated serum lactate levels was associated with a steeper drop in hemoglobin levels, presumably due to increase fluid administration, which was associated with a larger variance in blood pressure. Patients with elevated serum lactate levels also frequently presented with hyperglycemia, indicating a primary pathophysiological relevance of impaired insulin responsiveness in these patients. The impact of the surgery lengths on lactate levels was presumably mediated by increased blood loss and associated with increased need for metabolic recompensation.
Conclusion: We found that postoperative elevated serum lactate levels are primarily associated with the length of surgery and the pre- and intraoperative steroid administration but not with the histology or molecular subtype of the resected tumor.
