From the Section of Neurocritical Care (N.B.), Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore; Neurological Institute of New York (J.C., E.S.C.), NY; Department of Neurology (S.A.M., W.K.), Henry Ford Hospital, Detroit, MI; and Institute of Human Nutrition and Division of Preventive Medicine and Nutrition (S.C., W.K.), Department of Internal Medicine (D.S.), Columbia University College of Physicians and Surgeons, New York, NY.
Neurology. 2018 Jul 31;91(5):e421-e426. doi: 10.1212/WNL.0000000000005902. Epub 2018 Jun 29.
To understand nutritional and inflammatory factors contributing to serum glutamine levels and their relationship to hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH).
A prospective observational study of patients with SAH who had measurements of daily caloric intake and C-reactive protein, transthyretin, tumor necrosis factor α receptor 1a (TNFαR1a), glutamine, and nitrogen balance performed within 4 preset time periods during the 14 days after SAH. Factors associated with glutamine levels and HAIs were analyzed with multivariable regression. HAIs were tracked daily for time-to-event analyses. Outcome 3 months after SAH was assessed by the Telephone Interview for Cognitive Status and modified Rankin Scale.
There were 77 patients with an average age of 55 ± 15 years. HAIs developed in 18 (23%) on mean SAH day 8 ± 3. In a multivariable linear regression model, negative nitrogen balance ( = 0.02) and elevated TNFαR1a ( = 0.04) were independently associated with higher glutamine levels during the study period. The 14-day mean glutamine levels were lower in patients who developed HAI (166 ± 110 vs 236 ± 81 μg/mL, = 0.004). Poor admission Hunt and Hess grade ( = 0.04) and lower glutamine levels ( = 0.02) predicted time to first HAI. Low 14-day mean levels of glutamine were associated with a poor recovery on the Telephone Interview for Cognitive Status score ( = 0.03) and modified Rankin Scale score ( = 0.04) at 3 months after injury.
Declining glutamine levels in the first 14 days after SAH are influenced by inflammation and associated with an increased risk of HAI.
了解导致血清谷氨酰胺水平的营养和炎症因素及其与蛛网膜下腔出血（SAH）后医院获得性感染（HAI）的关系。
对 77 例 SAH 患者进行前瞻性观察研究，在 SAH 后 14 天内的 4 个预设时间段内，每天测量患者的热量摄入和 C 反应蛋白、转甲状腺素蛋白、肿瘤坏死因子α受体 1a（TNFαR1a）、谷氨酰胺和氮平衡。采用多元回归分析与谷氨酰胺水平和 HAI 相关的因素。每天跟踪 HAI 以进行时间事件分析。SAH 后 3 个月的预后通过电话认知状态测试和改良 Rankin 量表评估。
患者平均年龄为 55±15 岁，共有 18 例（23%）在平均 SAH 后第 8±3 天发生 HAI。在多元线性回归模型中，负氮平衡（ = 0.02）和 TNFαR1a 升高（ = 0.04）与研究期间谷氨酰胺水平升高独立相关。发生 HAI 的患者 14 天平均谷氨酰胺水平较低（166±110 vs 236±81 μg/ml， = 0.004）。入院时 Hunt 和 Hess 分级较差（ = 0.04）和谷氨酰胺水平较低（ = 0.02）预测首次发生 HAI 的时间。伤后 3 个月，14 天平均谷氨酰胺水平较低与电话认知状态评分（ = 0.03）和改良 Rankin 量表评分（ = 0.04）较差有关。
SAH 后 14 天内谷氨酰胺水平下降受炎症影响，并与 HAI 风险增加相关。
