Supplementation of essential amino acids may reduce the occurrence of infections in rehabilitation patients with brain injury.
BACKGROUND
To investigate whether supplementation with oral essential amino acids (EAAs) may reduce the occurrence of nosocomial infection among patients with brain injury (BI: stroke, trauma, anoxic coma).


METHODS
Patients (n = 125; 77 men, 48 women; mean age 63 ± 15 years) with stroke (68.8%), subarachnoid hemorrhage (17.6%), traumatic BI (7.2%), and anoxic BI (6.4%) 88 ± 15 days after the index event. Patients were randomly assigned to 2 months of oral EAAs (n = 63; 8 g/d) or placebo (n = 62).


RESULTS
Over the first month of rehabilitation, there were 60 infections in the whole population of 125 patients (48%); however, the rate was 23.2% lower in the EAA group (23 episodes/63 patients; 36.5%) than in the placebo group (37 episodes/62 patients; 59.7%) (P < .01). The types of infection were similarly distributed between the 2 groups. Serum levels of prealbumin <20 mg/dL and C-reactive protein (CRP) >0.3 mg/dL were the best predictors of future infection (prealbumin: odds ratio [OR] = 4.17, confidence interval [CI] 1.84-9.45, P < .001; CRP: OR = 3.8, CI 1.71-8.44, P < .001).


CONCLUSIONS
Supplementary EAAs may reduce the occurrence of nosocomial infections in rehabilitation patients with BI. Prealbumin and CRP are the best predictors of future infections.
Unità di Riabilitazione Neuromotoria, Unità Gravi Cerebrolesioni Acquisite, Fondazione S. Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy
Mirella
M
Boselli
Roberto
R
Aquilani
Paola
P
Baiardi
Francesco Saverio
FS
Dioguardi
Caterina
C
Guarnaschelli
Maria Pia
MP
Achilli
Nadia
N
Arrigoni
Paolo
P
Iadarola
Manuela
M
Verri
Simona
S
Viglio
Annalisa
A
Barbieri
Federica
F
Boschi
D000368:Aged; D000601:Amino Acids, Essential / Q000494:pharmacology / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation; D002097:C-Reactive Protein / Q000378:metabolism; D003128:Coma / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000188:drug therapy / Q000534:rehabilitation; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011228:Prealbumin / Q000378:metabolism; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D000071939:Stroke Rehabilitation; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000188:drug therapy* / Q000534:rehabilitation
D000601:Amino Acids, Essential; D000890:Anti-Infective Agents; D011228:Prealbumin; D002097:C-Reactive Protein