Serum glutamine and hospital-acquired infections after aneurysmal subarachnoid hemorrhage.
Badjatia N, Cremers S, Claassen J, Connolly ES, Mayer SA, Karmally W, and Seres D. Serum glutamine and hospital-acquired infections after aneurysmal subarachnoid hemorrhage. Neurology 2018; 91(5):e421-e426.
OBJECTIVE: To understand nutritional and inflammatory factors contributing to serum glutamine levels and their relationship to hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH).
METHODS: 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.
RESULTS: 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 (
CONCLUSIONS: Declining glutamine levels in the first 14 days after SAH are influenced by inflammation and associated with an increased risk of HAI.