Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study
Abstract
:1. Background
2. Methods
2.1. Biomarker Assessments
2.2. Outcome Measurements
2.3. Statistics
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ACA | anterior cerebral arteries |
aEEG | amplitude-integrated electroencephalography |
ALT | alanine transaminase |
AST | aspartate transaminase |
EEG | electroencephalography |
CK | creatine kinase |
HIE | hypoxic-ischemic encephalopathy |
LDH | lactate dehydrogenase |
MCA | medial cerebral arteries |
PI | pulsatility index |
RI | resistance index |
References
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Non-Hypothermia n = 32 | Hypothermia n = 32 | p Value | Total n = 64 | |
---|---|---|---|---|
Gestational age | 38.0 ± 1.5 | 37.7 ± 1.4 | 0.430 | 37.9± 1.4 |
Gender (M/F) | 17/15 | 14/18 | 0.617 | 31/33 |
Birth body weight (gm) | 2789 ± 507 | 2905 ± 462 | 0.165 | 2847 ± 485 |
HIE | <0.001 | |||
Stage 1 | 19 | 1 | 20 | |
Stage 2 | 3 | 18 | 21 | |
Stage 3 | 4 | 13 | 17 | |
No HIE | 6 | 0 | 6 | |
Apgar Score | ||||
1 min | 3 ± 2 | 2 ± 2 | 0.050 | 3 ± 2 |
5 min | 5 ± 2 | 4 ± 3 | 0.095 | 5 ± 2 |
Vital signs on admission | ||||
Systolic blood pressure | 64 ± 10 | 68 ± 15 | 0.172 | |
Diastolic blood pressure | 39 ± 11 | 40 ± 10 | 0.514 | |
Heart rate | 144 ± 20 | 141 ± 27 | 0.588 | |
Sentinel events | 0.129 | |||
Uterine rupture | 0 | 5 | 5 | |
Placenta abruption | 5 | 8 | ||
Shoulder dystocia | 1 | 0 | 1 | |
Maternal complications | 0.032 | |||
Preeclampsia/eclampsia | 0 | 4 | 4 | |
PIH | 1 | 6 | 7 | |
GDM | 2 | 2 | 4 | |
Outcomes | ||||
Death | 3 | 7 | 0.302 | 10 |
Severe disability | 2 | 4 | 0.672 | 6 |
No Hypothermia (n = 32) | Hypothermia (n = 32) | |||||||
---|---|---|---|---|---|---|---|---|
Mean ± SD | OR | 95% CI | p Value | Mean ± SD | OR | 95% CI | p Value | |
HIE stage | 1 ± 1 | 16.52 | 2.19–124.10 | 0.006 | 2 ± 0 | 0.998 | ||
Biochemistry variables | ||||||||
PH | 7.18 ± 0.20 | <0.001 | 0.00–0.17 | 0.015 | 6.98 ± 0.26 | 0.001 | 0.00–0.15 | 0.008 |
HCO3 | 13.8 ± 4.1 | 0.060 | 12.3 ± 4.0 | - | - | 0.052 | ||
BE | −14.2 ± 6.1 | 0.65 | 0.45–0.94 | 0.023 | −18.8 ± 5.98 | 0.70 | 0.54–0.92 | 0.009 |
AST | 111 ± 113 | - | - | 0.154 | 226 ± 276 | - | - | 0.297 |
ALT | 32 ± 43 | - | - | 0.110 | 65 ± 73 | - | - | 0.276 |
LDH | 1081 ± 1170 | - | - | 0.477 | 1995 ± 1791 | - | - | 0.192 |
Creatinine | 0.82 ± 0.19 | - | - | 0.070 | 0.86 ± 0.25 | - | - | 0.579 |
Lactate | 8.9 ± 2.4 | - | - | 0.161 | 12.8 ± 6.3 | 1.22 | 1.04–1.44 | 0.015 |
CK | 2169 ± 5842 | - | - | 0.073 | 1534 ± 1374 | - | - | 0.830 |
TnT | 0.17 ± 0.14 | - | - | 0.757 | 0.45 ± 0.55 | - | - | 0.330 |
Ammonia | 52 ± 68 | - | - | 0.322 | 108 ± 129 | 1.02 | 1.00–1.04 | 0.036 |
Doppler ultrasound | ||||||||
Peak velocity | ||||||||
ACA | 21.5 ± 8.9 | - | - | 0.557 | 20.7 ± 8.5 | - | - | 0.376 |
MCA | 36.9 ± 13.4 | - | - | 0.438 | 35.0 ± 15.4 | - | - | 0.417 |
Diastolic velocity | ||||||||
ACA | 5.3 ± 4.1 | - | - | 0.492 | 8.1 ± 5.9 | - | - | 0.171 |
MCA | 9.3 ± 6.6 | - | - | 0.210 | 14.1 ± 10.3 | 1.13 | 1.02–1.25 | 0.026 |
Resistance index | ||||||||
ACA | 0.76 ± 0.14 | - | - | 0.179 | 0.64 ± 0.15 | - | - | 0.077 |
MCA | 0.74 ± 0.14 | - | - | 0.984 | 0.61 ± 0.17 | <0.001 | 0.00–0.13 | 0.012 |
Pulsatility index | ||||||||
ACA | 1.45 ± 0.51 | - | - | 0.196 | 1.09 ± 0.55 | 0.201 | ||
MCA | 1.50 ± 0.65 | - | - | 0.107 | 1.05 ± 0.40 | 0.05 | 0.004–0.54 | 0.015 |
No Hypothermia n = 32 | Hypothermia n = 32 | |||||||
---|---|---|---|---|---|---|---|---|
Mean ± SD | OR | 95% CI | p Value | Mean ± SD | OR | 95% CI | p Value | |
Biochemistry variables | ||||||||
PH | 7.34 ± 0.23 | - | - | 0.053 | 7.38 ± 0.08 | - | - | 0.271 |
HCO3 | 23.1 ± 5.6 | - | - | 0.229 | 27.6 ± 4.4 | - | - | 0.234 |
BE | −2.5 ± 8.5 | 0.88 | 0.79–0.99 | 0.026 | 1.8 ± 3.9 | - | - | 0.171 |
AST | 75 ± 37 | - | - | 0.183 | 150 ± 147 | - | - | 0.247 |
ALT | 30 ± 34 | - | - | 0.070 | 78 ± 82 | - | - | 0.669 |
LDH | 751 ± 445 | - | - | 0.276 | 1779 ± 1547 | - | - | 0.255 |
Creatinine | 0.57 ± 0.28 | - | - | 0.731 | 0.71 ± 0.42 | - | - | 0.493 |
Lactate | 2.3 ± 0.9 | - | - | 0.604 | 2.7 ± 2.2 | 2.97 | 1.28–6.90 | 0.011 |
CK | 1016 ± 1421 | - | - | 0.844 | 2387 ± 2483 | - | - | 0.692 |
TnT | 0.11 ± 0.10 | - | - | 0.055 | 0.24 ± 0.29 | - | - | 0.054 |
Ammonia | 27 ± 12 | - | - | 0.982 | 29 ± 16 | - | - | 0.084 |
Doppler ultrasound | ||||||||
Peak velocity | ||||||||
ACA | 32.4 (7.4) | - | - | 0.518 | 30.4 (10.4) | 1.13 | 1.02–1.26 | 0.023 |
MCA | 52.1 (14.8) | - | - | 0.129 | 55.7 (23.2) | 1.11 | 1.02–1.20 | 0.012 |
Diastolic velocity | ||||||||
ACA | 10.0 (4.1) | - | - | 0.894 | 11.3 (7.5) | 1.21 | 1.04–1.41 | 0.014 |
MCA | 16.4 (7.5) | - | - | 0.507 | 22.7 (13.8) | 1.10 | 1.02–1.18 | 0.015 |
Resistance index | ||||||||
ACA | 0.69 (0.09) | - | - | 0.539 | 0.65 (0.16) | 0.001 | 0.00–0.81 | 0.043 |
MCA | 0.71 (0.12) | - | - | 0.648 | 0.62 (0.14) | - | - | 0.275 |
Pulsatility index | ||||||||
ACA | 1.25 (0.30) | - | - | 0.362 | 1.11 (0.42) | - | - | 0.064 |
MCA | 1.24 (0.31) | 0.643 | 1.07 (0.32) | 0.002 | 0.00–0.25 | 0.011 |
Univariate | Multivariable Model 1 | Multivariable Model 2 | ||||||
---|---|---|---|---|---|---|---|---|
OR | p Value | OR | 95% CI | p Value | OR | 95% CI | p Value | |
Significant variables with 6 h of age | ||||||||
PH | 0.001 | 0.008 | - | - | - | - | - | - |
BE | 0.701 | 0.009 | - | - | - | - | - | - |
Lactate | 1.221 | 0.015 | 1.32 | 1.04–1.69 | 0.024 | 1.28 | 1.00–1.63 | 0.046 |
Ammonia | 1.019 | 0.036 | - | - | - | - | - | - |
Diastolic velocity | ||||||||
MCA | 1.126 | 0.026 | 1.19 | 1.01–1.42 | 0.043 | - | - | - |
Resistance index | ||||||||
MCA | <0.001 | 0.012 | - | - | - | - | - | - |
Pulsatility index | ||||||||
MCA | 0.045 | 0.015 | - | - | - | 0.04 | 0.003–0.59 | 0.019 |
Significant variables at the 4th day old | ||||||||
Lactate | 2.972 | 0.011 | 4.11 | 1.14–14.81 | 0.031 | 5.31 | 1.16–24.43 | 0.032 |
Peak velocity | ||||||||
ACA | 1.130 | 0.023 | - | - | - | - | - | - |
MCA | 1.084 | 0.011 | - | - | - | - | - | - |
Diastolic velocity | ||||||||
ACA | 1.211 | 0.014 | - | - | - | - | - | - |
MCA | 1.066 | 0.046 | 1.05 | 0.965–1.15 | 0.254 | - | - | - |
Resistive index | ||||||||
ACA | 0.001 | 0.042 | - | - | - | - | - | - |
Pulsatility index | ||||||||
MCA | 0.002 | 0.011 | - | - | - | 0.002 | 0.00–0.69 | 0.037 |
AUC | Cut-Off Value | Specificity (%) | Sensitivity (%) | PPV (%) | NPV (%) | p Value | |
---|---|---|---|---|---|---|---|
Significant variables within 6 h of age | |||||||
Lactate | 0.803 | 14.0 | 0.625 | 0.938 | 0.714 | 0.909 | 0.015 |
PI of MCA | 0.818 | 1.15 | 0.778 | 0.850 | 0.895 | 0.700 | 0.015 |
Significant variables at the 4th day old | |||||||
Lactate | 0.859 | 2.80 | 0.818 | 0.905 | 0.905 | 0.818 | 0.011 |
PI of MCA | 0.849 | 1.05 | 0.727 | 0.938 | 0.833 | 0.889 | 0.011 |
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Tu, Y.-F.; Wu, P.-M.; Yu, W.-H.; Li, C.-I.; Wu, C.-L.; Kang, L.; Lin, Y.-C.; Shih, H.-I.; Huang, C.-C. Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study. Life 2021, 11, 1193. https://doi.org/10.3390/life11111193
Tu Y-F, Wu P-M, Yu W-H, Li C-I, Wu C-L, Kang L, Lin Y-C, Shih H-I, Huang C-C. Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study. Life. 2021; 11(11):1193. https://doi.org/10.3390/life11111193
Chicago/Turabian StyleTu, Yi-Fang, Po-Ming Wu, Wen-Hao Yu, Chung-I Li, Cheng-Lin Wu, Lin Kang, Yung-Chieh Lin, Hsin-I Shih, and Chao-Ching Huang. 2021. "Lactate Predicts Neurological Outcomes after Perinatal Asphyxia in Post-Hypothermia Era: A Prospective Cohort Study" Life 11, no. 11: 1193. https://doi.org/10.3390/life11111193