Admission Serum Lactate and 48-Hour Lactate Clearance for Predicting Discharge Glasgow Outcome Scale and In-Hospital Survival in Traumatic Brain Injury: A Prospective Cohort Study

Abstract

Background: Traumatic brain injury (TBI) triggers a neurometabolic crisis with mitochondrial decoupling and systemic hyperlactatemia. Accessible biomarkers are needed in resource-limited centers.

Objective: To evaluate admission venous serum lactate and 48-hour clearance for predicting discharge Glasgow Outcome Scale (GOS) and in-hospital survival in acute TBI.

Methods: In this prospective cohort study (Palembang, Indonesia; May–August 2025), 33 consecutive TBI patients (aged 14–71 years) presenting within 6 hours of trauma had venous lactate measured at 0, 24 and 48 hours. Discharge GOS was dichotomized into unfavorable (1–3) and favorable (4–5). Analyses used ROC curves, Kaplan-Meier survival, logistic regression and Cox models.

Results: Mean age was 37.91 ± 16.42 years; 63.6% were male. Admission lactate rose across worsening GOS strata (p = 0.002) and was higher in unfavorable (n = 20) than favorable (n = 13) outcomes (median 4.10 [IQR 3.18–5.12] vs. 1.80 [1.40–2.30] mmol/L; p < 0.001), with lower 48-hour clearance (+8.2% vs. +31.4%; p < 0.001). The AUC was 0.906 (95% CI: 0.804–1.000) at > 2.50 mmol/L (sensitivity 85.0%, specificity 84.6%). Survival was 92.9% at or below and 63.2% above it (Log-Rank p = 0.034). After adjustment for age and initial GCS, each 1.0 mmol/L increase in admission lactate was associated with unfavorable outcome (aOR 2.15, 95% CI: 1.12–4.13; p = 0.021) and mortality (aHR 1.78, 95% CI: 1.05–3.01; p = 0.032).

Conclusion: Admission lactate showed good discrimination for unfavorable GOS and in-hospital mortality in this small single-center cohort; 48-hour clearance differed between outcome groups. External validation is needed.