The role of cerebrospinal fluid S100 and lactate to predict clinically evident spinal cord ischaemia in thoraco-abdominal aortic surgery.
OBJECTIVE
Detecting spinal cord ischemia early during replacement of the thoracoabdominal aorta remains a challenge. In a high risk population, we have re-evaluated the potential impact of ischaemia/damage markers (S100, lactate) in the peripheral blood and CSF for perioperative patient management.


METHODS
Thirteen patients undergoing replacement of the thoracoabdominal aorta (6 female, age 63 (27-71)) with continuous CSF pressure monitoring and drainage were entered into the study. A total of 485 CSF (C) and serum (S) samples were collected and analysed for S100, lactate and glucose.


RESULTS
Two patients suffered from spinal cord injury (SCI) (15%). During and early after surgery, there was a strong correlation between C-S100 levels (r=0.79) and C-lactate levels (r=0.77) with time in patients with SCI. In patients with SCI C-lactate levels increased soon after aortic cross-clamping, whereas C-S100 levels did not become significantly elevated until 6 hours after cross-clamping.


CONCLUSIONS
An increase of C-lactate occurs much earlier than the increase in C-S100 in patients with SCI. Both parameters may be used to adjust protective and therapeutic measures intra- and postoperatively.
Khaladj
N
N
Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany. khaladj.nawid@mh-hannover.de
Teebken
O E
OE
Hagl
C
C
Wilhelmi
M H
MH
Tschan
C
C
Weissenborn
K
K
Lichtinghagen
R
R
Hoy
L
L
Haverich
A
A
Pichlmaier
M
M
D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000097:blood / Q000134:cerebrospinal fluid / Q000601:surgery*; D015415:Biomarkers / Q000134:cerebrospinal fluid; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood / Q000134:cerebrospinal fluid*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D012107:Research Design; D009418:S100 Proteins / Q000097:blood / Q000134:cerebrospinal fluid*; D013119:Spinal Cord Injuries / Q000134:cerebrospinal fluid / Q000209:etiology / Q000517:prevention & control; D020760:Spinal Cord Ischemia / Q000097:blood / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology; D013997:Time Factors; D015854:Up-Regulation
D015415:Biomarkers; D009418:S100 Proteins; D019344:Lactic Acid