Kapoor Ankur, Dhandapani Sivashanmugam, Gaudihalli Sachin, Dhandapani Manju, Singh Harminder, Mukherjee Kanchan K
a Department of Neurosurgery , Post Graduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India.
b National Institute of Nursing Education (NINE), PGIMER , Chandigarh , India.
Br J Neurosurg. 2018 Feb;32(1):47-52. doi: 10.1080/02688697.2017.1344615. Epub 2017 Jun 29.
The role of nutritional markers on outcome following subarachnoid hemorrhage (SAH) has been scarcely described.
This is a prospective study of 273 patients with SAH, in which haemoglobin, serum protein and albumin were measured within 24 hours and again at one week following ictus, and analysed with respect to other variables. New neurologic deficits (NND), infarct, mortality and Glasgow outcome scale (GOS) at 3 months were assessed.
The values of haemoglobin, total protein and albumin showed significant (p < .001) decline over the first week of SAH. Patients who developed NND had significantly lower serum albumin levels at admission compared to others (median 3.6 vs 3.9 g/dL, p < .001). Patients having lower albumin (≤3.5 gm/dL) levels at admission had significantly higher rates of NND (52% vs 20%), infarct (35% vs 23%), mortality (28% vs 16%) and unfavourable GOS (38% vs 25%). Hunt & Hess (H&H) grade and Fisher grade also affected all the outcome parameters significantly. Percentage decrease in albumin levels at one week following ictus significantly affected mortality and unfavourable GOS. On multivariate analyses, Fisher grade and lower admission albumin levels had significant impact on NND, while percentage decrease in albumin levels had significant impact on mortality and unfavourable GOS, independent of other nutritional markers and known prognostic variables.
Serum albumin levels following SAH can be useful to predict development of NND, while its further weekly decrease correlates independently with unfavourable outcome at 3 months. Albumin assessment being readily available may serve as more than a mere nutritional parameter in SAH.
蛛网膜下腔出血（SAH）后营养指标对预后的作用鲜有描述。
这是一项对273例SAH患者的前瞻性研究，在发病24小时内及发病一周后测量血红蛋白、血清蛋白和白蛋白，并分析其他变量。评估3个月时的新发神经功能缺损（NND）、梗死、死亡率和格拉斯哥预后评分（GOS）。
SAH第一周内，血红蛋白、总蛋白和白蛋白值显著下降（p < 0.001）。与其他患者相比，发生NND的患者入院时血清白蛋白水平显著更低（中位数3.6 vs 3.9 g/dL，p < 0.001）。入院时白蛋白水平较低（≤3.5 gm/dL）的患者NND发生率（52% vs 20%）、梗死发生率（35% vs 23%）、死亡率（28% vs 16%）和不良GOS评分率（38% vs 25%）显著更高。Hunt & Hess（H&H）分级和Fisher分级也对所有预后参数有显著影响。发病一周后白蛋白水平的下降百分比对死亡率和不良GOS评分有显著影响。多因素分析显示，Fisher分级和较低的入院白蛋白水平对NND有显著影响，而白蛋白水平的下降百分比对死亡率和不良GOS评分有显著影响，独立于其他营养指标和已知的预后变量。
SAH后的血清白蛋白水平可用于预测NND的发生，而其每周的进一步下降与3个月时的不良预后独立相关。白蛋白评估易于获得，在SAH中可能不仅仅是一个单纯的营养参数。
