Changes of arterial ketone body ratio (AKBR) in patients with intracerebral hemorrhage

: The arterial ketone body ratio (AKBR) is considered to be an accurate index of the functional reserve of the liver, and the validity of this idea has been confirmed in the field of abdominal surgery. We found low AKBR value intracerebral hemorrhage patients and discussed the clinical significance of this finding in this paper. Twenty-five patients with intracerebral hemorrhage treated at our institution were included in this study. Their ages ranged from 42 to 86 years old (average 68.5 years). There were 13 cases of putaminal hemorrhage and 12 cases of thalamic hemorrhage. Evacuation of the hematoma or ventricle drainage was performed in 20 of these cases within 3 days after symptoms of intracerebral hemorrhage appeared. There were 12 cases with intraventricular hemorrhage. The outcome of these patients was as follows; 17 cases survived, eight cases died. We collected blood samples on days 1, 2, 3, 7 and 10 after the onset of symptoms (day 0) and measured the following: 1, beta-hydroxybutyrate; 2, acetoacetate; 3, epinephrine; 4, norepinephrine. On day 0 total ketone body levels were higher (246.3 +/- 231.7 mumol/l), AKBR values (0.60 +/- 0.18) were significantly lower than in the control group (2.05 +/- 1.35) (p < 0.001). However, both epinephrine and norepinephrine levels were significantly higher, 638.4 +/- 229.0 pg/ml and 1036.5 +/- 288.2 pg/ml, respectively. The AKBR value was 0.76 +/- 0.19 on day 1, 1.04 +/- 0.30 on day 2, and increased thereafter. In addition, the relation between sequential changes of AKBR in patients with intraventricular hemorrhage and outcome were also discussed. AKBR values are known to decrease not only in cases of hepatic failure, but in cases in which the liver energy charge is reduced, such as shock and hypoxemia, but no investigations have ever been performed to determine whether AKBR is altered in cerebrovascular disease. In this study, we found that AKBR values were lower in intracerebral hemorrhage, presumably due to reduced hepatic blood flow causes by increased levels of epinephrine and norepinephrine. In addition, our findings suggest that the fluctuations in AKBR values correlated with the outcome of intracerebral hemorrhage patients.