Metabolic profiles of patients with subarachnoid hemorrhage treated by early surgery.
OBJECTIVE
This study was conducted to evaluate the metabolic response of patients with subarachnoid hemorrhage (SAH) and to determine whether the severity of hemorrhage influenced the response.


METHODS
Resting energy expenditure, nitrogen balance, and serum rapid-turnover proteins were studied for 3-day periods at Day 4, Day 10, and before discharge in patients with SAH who underwent surgical clipping within 2 days after the onset. The patients were divided into two groups according to the Hunt and Hess classification system; there were 17 patients with Grade I or II (mild group) and 19 patients with Grade III, IV, or V (severe group).


RESULTS
The mean resting energy expenditures (mean+/-standard deviation) were highest on Day 10, which were 146+/-24% and 198+/-78% of basal energy expenditure in the mild and severe groups, respectively. The nitrogen balance levels of the mild group on Days 4 and 10 were -3.0+/-3.5 g per day and -4.5+/-2.9 g per day, and those of the severe group were -7.5+/-3.2 g per day and -9.2+/-4.1 g per day, respectively. There was a significant difference in the nitrogen balance over time between the two groups (P=0.0037). Serum transferrin, prealbumin, and retinol-binding protein levels were lowest on Day 4 and gradually increased. There were no significant differences in these parameters between the two groups.


CONCLUSIONS
SAH treated by surgery induces a profound stress response. A significant difference of increased catabolism but not decreased anabolism between the mild and severe groups was noted.
Kasuya
H
H
Section of Neurosurgery, Saitamaken Saiseikai Kurihashi Hospital, Saitama, Japan.
Kawashima
A
A
Namiki
K
K
Shimizu
T
T
Takakura
K
K
D000368:Aged; D001798:Blood Proteins / Q000032:analysis; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000652:urine; D013345:Subarachnoid Hemorrhage / Q000378:metabolism* / Q000601:surgery*; D013997:Time Factors
D001798:Blood Proteins; D004044:Dietary Proteins; D009584:Nitrogen