Scholarlink

Objectives <p>Patients with aneurysmal subarachnoid hemorrhage (aSAH) are at high risk of secondary ischemia, and timely insight into cerebral metabolism may improve clinical management. Cerebral microdialysis offers continuous metabolic monitoring but is invasive, focal, and confined to specialized centers. Peripheral blood and cerebrospinal fluid (CSF) could provide less invasive, more accessible surrogates for assessing cerebral metabolic status. This study aimed to evaluate glucose and lactate dynamics across blood, CSF, and brain parenchyma in patients with severe aSAH.</p> Patients and Methods <p>A total of 39 patients with aSAH undergoing multimodal neuromonitoring were retrospectively analyzed. Glucose and lactate levels from plasma, CSF, and cerebral microdialysis were matched within 90-min intervals relative to each microdialysis measurement. Associations were analyzed using linear mixed-effects models.</p> Results <p>Plasma (<i>p</i> &lt; 0.001) and CSF (<i>p</i> &lt; 0.001) glucose levels were significantly associated with cerebral glucose concentrations. Moderate correlations were observed between plasma–brain (<i>r</i> = 0.54) and plasma–CSF (<i>r</i> = 0.55), while CSF–brain correlation was weaker (<i>r</i> = 0.36). For lactate, significant associations were found between CSF and brain (<i>p</i> = 0.04; <i>r</i> = 0.24) and between plasma and CSF (<i>p</i> &lt; 0.001; <i>r</i> = 0.33), but plasma–brain lactate showed no significant relationship.</p> <p>The plasma–brain glucose association weakened slightly over time (<i>p</i> = 0.008) and strengthened during episodes of low brain tissue oxygenation (pbtO<sub>2</sub> &lt; 15&#xa0;mm Hg; <i>p</i> = 0.01). Insulin had no effect on glucose relationships but significantly attenuated the plasma–brain lactate association (<i>p</i> &lt; 0.001). The presence of metabolic crisis (lactate/pyruvate ratio &gt; 40) strengthened the CSF–brain lactate association (<i>p</i> = 0.04). CSF cell count had no significant effect.</p> Conclusions <p>In severe aSAH, glucose and lactate levels in blood and CSF reflect cerebral values in a compartment- and metabolite-specific manner, but with high variability influenced by clinical conditions. These findings suggest that blood and CSF provide only limited information about cerebral metabolism, highlighting the complementary value of cerebral microdialysis for individualized, brain-targeted monitoring.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Glucose and Lactate Concentrations in Plasma, Cerebrospinal Fluid, and Brain Parenchyma Following Aneurysmal Subarachnoid Hemorrhage: A Cross-compartmental Correlation Study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月4日

查看全文
  • Niko Schmaling,
  • Miriam M. Moser,
  • Lena Weyer,
  • Robin Ristl,
  • Walter Plöchl,
  • Andrea Reinprecht,
  • Johannes Herta,
  • Karl Rössler,
  • Arthur Hosmann

摘要

Objectives

Patients with aneurysmal subarachnoid hemorrhage (aSAH) are at high risk of secondary ischemia, and timely insight into cerebral metabolism may improve clinical management. Cerebral microdialysis offers continuous metabolic monitoring but is invasive, focal, and confined to specialized centers. Peripheral blood and cerebrospinal fluid (CSF) could provide less invasive, more accessible surrogates for assessing cerebral metabolic status. This study aimed to evaluate glucose and lactate dynamics across blood, CSF, and brain parenchyma in patients with severe aSAH.

Patients and Methods

A total of 39 patients with aSAH undergoing multimodal neuromonitoring were retrospectively analyzed. Glucose and lactate levels from plasma, CSF, and cerebral microdialysis were matched within 90-min intervals relative to each microdialysis measurement. Associations were analyzed using linear mixed-effects models.

Results

Plasma (p < 0.001) and CSF (p < 0.001) glucose levels were significantly associated with cerebral glucose concentrations. Moderate correlations were observed between plasma–brain (r = 0.54) and plasma–CSF (r = 0.55), while CSF–brain correlation was weaker (r = 0.36). For lactate, significant associations were found between CSF and brain (p = 0.04; r = 0.24) and between plasma and CSF (p < 0.001; r = 0.33), but plasma–brain lactate showed no significant relationship.

The plasma–brain glucose association weakened slightly over time (p = 0.008) and strengthened during episodes of low brain tissue oxygenation (pbtO2 < 15 mm Hg; p = 0.01). Insulin had no effect on glucose relationships but significantly attenuated the plasma–brain lactate association (p < 0.001). The presence of metabolic crisis (lactate/pyruvate ratio > 40) strengthened the CSF–brain lactate association (p = 0.04). CSF cell count had no significant effect.

Conclusions

In severe aSAH, glucose and lactate levels in blood and CSF reflect cerebral values in a compartment- and metabolite-specific manner, but with high variability influenced by clinical conditions. These findings suggest that blood and CSF provide only limited information about cerebral metabolism, highlighting the complementary value of cerebral microdialysis for individualized, brain-targeted monitoring.