Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage
Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage
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DOI：
10.1212/wnl.0000000000001259
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发表时间：
2015-02-17
期刊：
影响因子：
9.9
通讯作者：
Seres, David
中科院分区：
文献类型：
--
作者：
Badjatia, Neeraj;Monahan, Aimee;Seres, David
目的：分析炎症和负氮平衡（NBAL）对蛛网膜下腔出血（SAH）后营养状况和预后的影响。除每日热量摄入外，在出血后前14天（PBD）的4个预设时间段内测量C反应蛋白（CRP）、甲状腺素运载蛋白（TTR）、静息能量消耗（REE）和NBAL（g/天）。用多元线性回归分析REE和NBAL的相关因素。每天跟踪医院获得性感染（HAI），以进行至事件发生时间分析。不良结局在3个月被定义为一个修改后的兰金量表评分4和多因素Logistic回归评估。结果：有229例患者，平均年龄为55 - 15岁。REE水平越高，年龄越小（p = 0.02），男性越多（p < 0.001），Hunt Hess分级越高（p = 0.001），改良Fisher评分越高（p = 0.01）。阴性NBAL与较低的热量摄入（p < 0.001）、较高的体重指数（p < 0.001）、动脉瘤夹闭术（p = 0.03）和较高的CRP：TTR比值（p = 0.03）相关。53例（23%）患者在平均PBD 8 +/- 3时发生HAI。年龄较大（p = 0.002）、Hunt Hess评分较高（p < 0.001）、热量摄入较低（p = 0.001）和NBAL阴性（p = 0.04）可预测首次HAI的时间。3个月时不良预后与Hunt Hess分级较高（p < 0.001）、年龄较大（p < 0.001）、阴性NBAL（p = 0.01）、HAI（p = 0.03）、CRP：TTR比值较高（p = 0.04）、体重指数较高（p = 0.03）和迟发性脑缺血（p = 0.04）相关。结论：SAH后阴性NBAL受炎症影响，与HAI和不良预后风险增加相关。喂养不足和全身炎症是SAH后NBAL阴性和预后不良的潜在可改变的危险因素。
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.