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Peer-reviewedCC BY 4.0Frontiers in Neurology

Is admission lactate an independent prognostic marker or a reflection of injury severity in severe traumatic brain injury?

  • Fuli Yan1,2
  • Hao Liu3,4
  • Mingang Liang1
  • Wenya Gao1
  • Lun Dong2
  • Jian Wu1
  • Jun Zhang5
  • Mingfei Yang6,7
7 affiliations
  1. 1Graduate School, Qinghai University
  2. 2Department of Neurosurgery, Clinical Medical College of Yangzhou University
  3. 3Department of Neurosurgery, Huai'an Clinical Medical College of Jiangsu University
  4. 4Huai'an Hospital of Huai'an City
  5. 5Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
  6. 6Department of Neurosurgery, Qinghai Provincial People's Hospital
  7. 7National Regional Medical Center for Qinghai (Qinghai Hospital, The First Affiliated Hospital of Xi'an Jiaotong University)
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Abstract

Objective: Although admission lactate is associated with poor outcomes after severe traumatic brain injury, its independent prognostic value remains uncertain. This study aimed to determine whether admission lactate is an independent prognostic marker or primarily a reflection of injury severity.

Methods: In a two-center retrospective study of patients with sTBI (GCS ≤ 8) (development cohort, n = 287; external validation cohort, n = 185), we assessed whether the association between admission lactate and 30-day mortality remained independent of established severity markers (age, GCS, pupillary reactivity, and Rotterdam CT score) and quantified the incremental prognostic value of lactate beyond this severity baseline, with external validation. Exploratory in vitro experiments in hypoxic SH-SY5Y cells were performed as a secondary analysis to examine cellular responses to lactate under hypoxic conditions.

Results: Thirty-day mortality was 42.2% in the development cohort and 36.8% in the external validation cohort. Admission lactate was significantly associated with mortality on univariable analysis (OR per mmol/L, 1.50; 95% CI, 1.30–1.73). After adjustment for severity markers, the adjusted OR was 1.19 per mmol/L (95% CI, 1.00–1.42; P = 0.051), indicating a positive association with limited precision. Consistent with this finding, lactate provided minimal incremental prognostic value beyond the severity baseline (ΔAUC, +0.005; P = 0.31), and these results were reproduced in the external validation cohort. Nevertheless, in vitro experiments suggested a potential biological activity of lactate that warrants further investigation.

Conclusion: In these two selected adult sTBI cohorts, admission lactate was associated with 30-day mortality but provided little incremental prognostic information beyond established neurological severity markers. Its role should therefore be interpreted as adjunctive rather than as a stand-alone prognostic factor. The exploratory in vitro findings warrant further mechanistic investigation.

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Cite

BibTeXRIS
BibTeX
@article{yan2026admission,
  title = {{Is admission lactate an independent prognostic marker or a reflection of injury severity in severe traumatic brain injury?}},
  author = {Fuli Yan and Hao Liu and Mingang Liang and Wenya Gao and Lun Dong and Jian Wu and Jun Zhang and Mingfei Yang},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1920098},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1920098/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Is admission lactate an independent prognostic marker or a reflection of injury severity in severe traumatic brain injury?
AU  - Fuli Yan
AU  - Hao Liu
AU  - Mingang Liang
AU  - Wenya Gao
AU  - Lun Dong
AU  - Jian Wu
AU  - Jun Zhang
AU  - Mingfei Yang
PY  - 2026
DA  - 2026/10/19
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1920098
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1920098/full
AB  - Objective: Although admission lactate is associated with poor outcomes after severe traumatic brain injury, its independent prognostic value remains uncertain. This study aimed to determine whether admission lactate is an independent prognostic marker or primarily a reflection of injury severity.  Methods: In a two-center retrospective study of patients with sTBI (GCS ≤ 8) (development cohort, n = 287; external validation cohort, n = 185), we assessed whether the association between admission lactate and 30-day mortality remained independent of established severity markers (age, GCS, pupillary reactivity, and Rotterdam CT score) and quantified the incremental prognostic value of lactate beyond this severity baseline, with external validation. Exploratory in vitro experiments in hypoxic SH-SY5Y cells were performed as a secondary analysis to examine cellular responses to lactate under hypoxic conditions.  Results: Thirty-day mortality was 42.2% in the development cohort and 36.8% in the external validation cohort. Admission lactate was significantly associated with mortality on univariable analysis (OR per mmol/L, 1.50; 95% CI, 1.30–1.73). After adjustment for severity markers, the adjusted OR was 1.19 per mmol/L (95% CI, 1.00–1.42; P = 0.051), indicating a positive association with limited precision. Consistent with this finding, lactate provided minimal incremental prognostic value beyond the severity baseline (ΔAUC, +0.005; P = 0.31), and these results were reproduced in the external validation cohort. Nevertheless, in vitro experiments suggested a potential biological activity of lactate that warrants further investigation.  Conclusion: In these two selected adult sTBI cohorts, admission lactate was associated with 30-day mortality but provided little incremental prognostic information beyond established neurological severity markers. Its role should therefore be interpreted as adjunctive rather than as a stand-alone prognostic factor. The exploratory in vitro findings warrant further mechanistic investigation.
SN  - 1664-2295
ER  -