title: Relationship between energy balance and complications after subarachnoid hemorrhage.
abstract: 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.
authors.affiliation: Departments of Neurology, Neurosurgery, and Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA. nb2217@columbia.edu
authors.forename: Neeraj
authors.initials: N
authors.lastname: Badjatia
authors.forename: Luis
authors.initials: L
authors.lastname: Fernandez
authors.forename: Marin J
authors.initials: MJ
authors.lastname: Schlossberg
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Kiwon
authors.initials: K
authors.lastname: Lee
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenbaum
mesh_terms: 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*
chemical_list: D018686:Anesthetics, Intravenous; D005947:Glucose; D015742:Propofol