Les déterminants de l’hyperlactatémie au décours d'une intervention neurochirurgicale élective nécessitant une admission aux soins intensifs

Hyperlactatemia is accumulation in the blood of lactate from pyruvate. This increase can result from multiple causes, i.e. metabolic (aerobic or anaerobic), medicinal, toxic and congenital causes. The objective of this study is to understand the origin and cause of an elevation of lactate from patients hospitalized in intensive care after an elective brain tumour surgery. This is a retrospective study including 200 patients, older than 18 years, admitted in the intensive care service of the University Hospital Saint-Luc (Brussels) after an elective neurosurgical intervention of brain tumours from January 2016 to June 2017. The analysis focusses on different determinants, i.e. Propofol, Solumedrol, age, weight, BMI, HTA, blood sugar, Mannitol and operating time. The patients data was obtained from the Medical Explorer and Qcare programs, using their administrative number. This data was then encoded in Excel and transformed into long format for the purpose of statistical analyses. In the database, 200 patients (55% women, 45% men) were examined where 30 patients had hyperlactatemia with an average value of 1.73±1.6. The statistical analysis shows that Solumedrol (adjusted OR (95% CI): 3.41 (1.56-7.46); p = 0.002) and the operating time (adjusted OR (95% CI): 1.003 (1.001-1.009); p = 0.016) are risk factors that significantly affect the variation of lactate significantly. The study did not show a significant correlation between Propofol and hyperlactatemia. To conclude, there is no data yet in the scientific literature that shows the influence of Solumedrol and the operating time. This study made it possible to successfully assess risk factors that influence the lactate level on D0 at the admission to intensive care following elective neurosurgical intervention retrospectively.