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Journal of Parenteral and Enteral Nutrition
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Article

Relationship Between Energy Balance and Complications After Subarachnoid Hemorrhage

Neeraj Badjatia, MD, MSc*, Luis Fernandez, MD, Marin J. Schlossberg, J. Michael Schmidt, PhD, Jan Claassen, MD, Kiwon Lee, MD, E. Sander Connolly, MD, Stephan A. Mayer, MD, FCCM, and Michael Rosenbaum, MD

Columbia University College of Physicians and Surgeons

* To whom correspondence should be addressed. E-mail: nb2217{at}columbia.edu.


  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°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. (JPEN J Parenter Enteral Nutr. XXXX;XX:xxx-xxx)

First published on November 2, 2009
Journal of Parenteral and Enteral Nutrition 2009, doi:10.1177/0148607109348797
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