Metabolic profiles of patients with subarachnoid hemorrhage treated by early surgery

OBJECTIVE: This study was conducted to evaluate the metabolic response of patients with subarachnoid hemorrhage (SAH) and to determine whether the severity of hemorrhage influenced the response. METHODS: Resting energy expenditure, nitrogen balance, and serum rapid-turnover proteins were studied for 3-day periods at Day 4, Day 10, and before discharge in patients with SAH who underwent surgical clipping within 2 days after the onset. The patients were divided into two groups according to the Hunt and Hess classification system; there were 17 patients with Grade I or II (mild group) and 19 patients with Grade III, IV, or V (severe group). RESULTS: The mean resting energy expenditures (mean +/- standard deviation) were highest on Day 10, which were 146 +/- 24% and 198 +/- 78% of basal energy expenditure in the mild and severe groups, respectively. The nitrogen balance levels of the mild group on Days 4 and 10 were -3.0 +/- 3.5 g per day and -4.5 +/- 2.9 g per day, and those of the severe group were -7.5 +/- 3.2 g per day and -9.2 +/- 4.1 g per day, respectively. There was a significant difference in the nitrogen balance over time between the two groups (P = 0.0037). Serum transferrin, prealbumin, and retinol-binding protein levels were lowest on Day 4 and gradually increased. There were no significant differences in these parameters between the two groups. CONCLUSION: SAH treated by surgery induces a profound stress response. A significant difference of increased catabolism but not decreased anabolism between the mild and severe groups was noted.