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This study assesses the behavior of serial blood lactate measurements during intensive care unit (ICU) stay to identify prognostic factors of unfavorable neurological outcomes (UO) in patients with aneurysmal subarachnoid hemorrhage (SAH).We retrospectively reviewed all patients who were consecutively hospitalized with SAH between 2009 and 2016. Arterial blood lactate levels were routinely obtained on admission and every 6 h in the ICU. Univariate/multivariate analyses were performed to identify independent predictors of UO (modified Rankin scale of 3–6 upon hospital discharge).There were 145 patients with 46% of UO. Initially, increased lactate levels reached maximum levels during the first 24 h and then decreased to within the normal range. Then, the levels slightly increased again to within the normal range for the next 24 h, especially in UO. On multiple regression analysis, lactate levels measured at 24 h, and 48 h after admission were strong predictors of UO. Lactate level measured at 48 h after admission demonstrated the greatest accuracy and the highest specificity (area under the curve, 0.716; sensitivity, 40%; specificity, 92.1%).The lactate level at 48 h after admission was the most accurate predictor of UO with a high specificity in SAH patients.In the unfavorable outcome group, initially increased lactate levels decreased to within the normal range for the first 24 h. Then, lactate levels slightly increased again to within the normal range for the next 24 h.The blood lactate level at each time point was greater in the unfavorable neurological outcome group than the favorable neurological outcome group.The lactate level at 48 h after admission was the most accurate predictor of unfavorable neurological outcomes in SAH patients.