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Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage
- Source :
- Neurology. 84(7)
- Publication Year :
- 2015
-
Abstract
- To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH).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.There were 229 patients with an average age of 55 ± 15 years. Higher REE was associated with younger age (p = 0.02), male sex (p0.001), higher Hunt Hess grade (p = 0.001), and higher modified Fisher score (p = 0.01). Negative NBAL was associated with lower caloric intake (p0.001), higher body mass index (p0.001), 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 (p0.001), 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 (p0.001), older age (p0.001), 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).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.
- Subjects :
- Male
medicine.medical_specialty
Subarachnoid hemorrhage
Nitrogen
Rest
Logistic regression
Systemic inflammation
Gastroenterology
Modified Rankin Scale
Internal medicine
Medicine
Humans
Prealbumin
Resting energy expenditure
Prospective Studies
Prospective cohort study
Inflammation
Cross Infection
biology
business.industry
C-reactive protein
Intracranial Aneurysm
Middle Aged
Subarachnoid Hemorrhage
medicine.disease
Prognosis
Surgery
C-Reactive Protein
biology.protein
Female
Neurology (clinical)
medicine.symptom
business
Energy Intake
Energy Metabolism
Body mass index
Subjects
Details
- ISSN :
- 1526632X
- Volume :
- 84
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- Neurology
- Accession number :
- edsair.doi.dedup.....3e1925b792ca79090a9caf17674eabbb