Lactate-Pyruvate Ratio and Mortality Association in Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality worldwide, particularly among young and productive populations. Prognostication remains a challenge, as traditional clinical tools such as the Glasgow Coma Scale (GCS) and vital signs often fail to capture underlying cellular metabolic derangements. The lactate-pyruvate ratio (LPR) reflects cellular redox balance and mitochondrial function and may serve as a novel prognostic marker. This prospective, observational, analytical study included 40 TBI patients admitted to Dr. Soetomo General Hospital, Surabaya, Indonesia, from May to July 2025. Demographic characteristics, vital signs, GCS scores, and blood levels of lactate and pyruvate were measured on admission. Patients were followed for seven days, and mortality outcomes were recorded. Logistic regression was used to evaluate the association between LPR and mortality. The majority of patients were male (72.5%) with a median age of 45 years. The mortality rate was 20% (8/48). Non-survivors had significantly higher heart rates, lower oxygen saturation, lower GCS scores, and markedly elevated lactate levels (median 3.99 mmol/L vs. 0.31 mmol/L in survivors, p<0.001). Pyruvate levels did not differ significantly. Higher lactate-to-pyruvate ratio (LPR) values were significantly associated with increased mortality, with most survivors clustering in the <20 group and non-survivors predominantly in higher categories (p < 0.001). Thus, LPR strongly correlates with in-hospital mortality and may serve as a valuable biochemical marker for early risk stratification in TBI patients. Routine measurement of LPR in emergency and critical care settings could improve prognostic accuracy and guide timely interventions. Larger multicenter studies are warranted to validate these findings.