Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage
Abstract
Objective:
To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH).
Methods:
This was a prospective observational study of SAH patients admitted between May 2008 and June 2012. Measurements of C-reactive protein (CRP), transthyretin (TTR), resting energy expenditure (REE), and NBAL (g/day) were performed over 4 preset time periods during the first 14 postbleed days (PBD) in addition to daily caloric intake. Factors associated with REE and NBAL were analyzed with multivariable linear regression. Hospital-acquired infections (HAI) were tracked daily for time-to-event analyses. Poor outcome at 3 months was defined as a modified Rankin Scale score ≥4 and assessed by multivariable logistic regression.
Results:
There were 229 patients with an average age of 55 ± 15 years. Higher REE was associated with younger age (p = 0.02), male sex (p < 0.001), higher Hunt Hess grade (p = 0.001), and higher modified Fisher score (p = 0.01). Negative NBAL was associated with lower caloric intake (p < 0.001), higher body mass index (p < 0.001), aneurysm clipping (p = 0.03), and higher CRP:TTR ratio (p = 0.03). HAIs developed in 53 (23%) patients on mean PBD 8 ± 3. Older age (p = 0.002), higher Hunt Hess (p < 0.001), lower caloric intake (p = 0.001), and negative NBAL (p = 0.04) predicted time to first HAI. Poor outcome at 3 months was associated with higher Hunt Hess grade (p < 0.001), older age (p < 0.001), negative NBAL (p = 0.01), HAI (p = 0.03), higher CRP:TTR ratio (p = 0.04), higher body mass index (p = 0.03), and delayed cerebral ischemia (p = 0.04).
Conclusions:
Negative NBAL after SAH is influenced by inflammation and associated with an increased risk of HAI and poor outcome. Underfeeding and systemic inflammation are potential modifiable risk factors for negative NBAL and poor outcome after SAH.
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© 2015 American Academy of Neurology.
Publication History
Received: May 23, 2014
Accepted: September 11, 2014
Published online: January 16, 2015
Published in print: February 17, 2015
Disclosure
N. Badjatia received funding support from the Irving Institute for Clinical and Translational Research at Columbia University and is currently the Associate Editor for Neurocritical Care. A. Monahan, A. Carpenter, J. Zimmerman, J. Schmidt, J. Claassen, and E. Connolly report no disclosures relevant to the manuscript. S. Mayer reports receiving honoraria from Edge Therapeutics and Actelion Pharmaceuticals. W. Karmally and D. Seres report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.
Study Funding
Supported by the National Center for Advancing Translational Sciences, NIH, through grant number KL2 TR000081, formerly the National Center for Research Resources, grant number KL2 RR024157. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Authors
Author Contributions
Dr. Badjatia: drafting/revising the manuscript for content, including medical writing for content; study concept or design; analysis or interpretation of data; study supervision or coordination. A. Monahan: drafting/revising the manuscript for content, including medical writing for content; acquisition of data. A. Carpenter: drafting/revising the manuscript for content, including medical writing for content; acquisition of data. J. Zimmerman: drafting/revising the manuscript for content, including medical writing for content; acquisition of data. Dr. Schmidt: drafting/revising the manuscript for content, including medical writing for content; analysis or interpretation of data. Dr. Claassen: drafting/revising the manuscript for content, including medical writing for content. Dr. Connolly: drafting/revising the manuscript for content, including medical writing for content. Dr. Mayer: drafting/revising the manuscript for content, including medical writing for content; analysis or interpretation of data. Dr. Karmally: drafting/revising the manuscript for content, including medical writing for content; acquisition of data; study supervision or coordination. Dr. Seres: drafting/revising the manuscript for content, including medical writing for content; analysis or interpretation of data; study supervision or coordination.
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- Identification of metabolites associated with preserved muscle volume after aneurysmal subarachnoid hemorrhage due to high protein supplementation and neuromuscular electrical stimulation, Scientific Reports, 14, 1, (2024).https://doi.org/10.1038/s41598-024-64666-5
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