Relationship between energy balance and complications after subarachnoid hemorrhage.
BACKGROUND
Subarachnoid hemorrhage patients are hypermetabolic and at risk for developing medical complications. A relationship was hypothesized between energy balance and complications following subarachnoid hemorrhage.


METHODS
Fifty-eight consecutive poor-grade subarachnoid hemorrhage patients (mean age, 58; range, 26-86; 66% women) were studied between 2005 and 2007. Caloric intake and energy expenditure were assessed. In-hospital complications over the first 14 days posthemorrhage were defined as renal failure, fever (>38.3 degrees C), any infection, anemia, hyperglycemia (>11 mmol/L), and myocardial infarction. Energy balance was calculated by subtracting energy expenditure from caloric intake.


RESULTS
Enteral nutrition was begun 1 day posthemorrhage (range, 0-5 days). Recommended (mean +/- SD) caloric intake was 28 +/- 3 kcal/kg/d, and the actual was 14 +/- 5 kcal/kg/d. Enteral nutrition accounted for 67% of caloric intake; propofol and dextrose infusions accounted for 33% of caloric intake. Cumulative energy balance over the first 7 days was -117 +/- 53 kcal/kg. The average energy balance during the first 7 days after subarachnoid hemorrhage significantly correlated with the total number of infectious complications (r = -0.5, P < .001) but not medical complications (r = -0.2, P = .1). After adjustment for Hunt-Hess grade, fever, hyperglycemia, and anemia, negative energy balance during the first 7 days after subarachnoid hemorrhage correlated with the number of infectious complications (P = .01).


CONCLUSIONS
Infectious complications after subarachnoid hemorrhage are associated with negative energy balance. Studies are needed to better understand the impact of negative energy balance on outcome after subarachnoid hemorrhage.
Badjatia
Neeraj
N
Departments of Neurology, Neurosurgery, and Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA. nb2217@columbia.edu
Fernandez
Luis
L
Schlossberg
Marin J
MJ
Schmidt
J Michael
JM
Claassen
Jan
J
Lee
Kiwon
K
Connolly
E Sander
ES
Mayer
Stephan A
SA
Rosenbaum
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D002149:Energy Intake; D004734:Energy Metabolism; D004750:Enteral Nutrition; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000378:metabolism*
D018686:Anesthetics, Intravenous; D005947:Glucose; D015742:Propofol