ArticlePloS one2025
Defining metabolic abnormalities in acute human traumatic brain injury with cerebral microdialysis and multimodality monitoring.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- The microdialysis-derived lactate-pyruvate gradient indicates anaerobic activity after brain injury.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2026Article
- Cerebral glycerol during haemorrhagic shock in normal and raised intracranial pressure resuscitated with total REBOA: an experimental porcine study.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Article
- Consensus statement from the 2025 Delphi panel on cerebral microdialysis in critical care.Critical care (London, England) · 2026Review
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Authors and funding
9 authors.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveWe aimed to compare the prevalence and multimodal associations of mitochondrial dysfunction as defined by published cerebral-microdialysis-based criteria versus our novel multimodality-monitoring-based criteria in acute traumatic brain injury patients.
methodsWe retrospectively analyzed neurocritical care monitoring data from 619 acute traumatic brain injury patients. Monitoring modalities included cerebral microdialysis, intracranial pressure, brain tissue oxygenation, cerebral perfusion pressure, and the pressure reactivity index. The cerebral-microdialysis-based criteria we compared combine an elevated lactate/pyruvate ratio (25 or 30) with raised concentrations of lactate (2.5 mM) or pyruvate (70 μM or 120 μM). Our multimodality-monitoring-based criteria comprise a consistent lactate/pyruvate ratio > 25 with intracranial pressure ≤ 20 mmHg, brain tissue oxygenation ≥ 15 mmHg, a pressure reactivity index ≤ 0.3, and cerebral glucose ≥ 1.0 mM.
resultsAcross 592 analyzable patients, a lactate/pyruvate ratio > 25 was common, with a median prevalence of 48.9% (41.5% with consistency) and a U-shaped, bimodal distribution. A lactate/pyruvate ratio > 25 was associated with lower glucose and higher glycerol, and when accompanied by high pyruvate (> 120 μM), this derangement was further distinguished by higher glutamate and cerebral perfusion pressure. Using multimodal criteria on a cohort of 268 patients, consistent mitochondrial dysfunction was identified in 25.7% to 41.0% of patients, often in the absence of other physiological derangements.
conclusionsMany acute traumatic brain injury patients constantly demonstrate neurometabolic derangements, among which clinical mitochondrial dysfunction is highly prevalent despite normal cerebral pressure, oxygenation, and perfusion. There is necessity for targeted, neurometabolic therapies in neurocritical care that address this abnormality.
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