Free Fatty Acids and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Badjatia, Neeraj; Seres, David S.; Carpenter, Amanda; Schmidt, J. Michael; Lee, Ki-Won; Mayer, Stephan A.; Claassen, Jan; Connolly, E. Sander; Elkind, Mitchell S.V.

doi:10.1161/strokeaha.111.636035

Cited by 29 publications

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“…In previous studies, we and others have identified the importance of assessing free fatty acid metabolism and supplementation on the occurrence of DCI. 18,42,43 Protein energy malnutrition identified in this study may be another target for intervention with amino acid supplementation. Prospective studies assessing the impact of specific amino acids and inflammation on outcome are needed to determine whether immunomodulation with nutritional supplementation may provide benefit after SAH.…”

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confidence: 87%

“…Our methodology for IDC has been described previously. 17,18 In mechanically ventilated subjects, the IDC circuit system was connected to the oxygen delivery and exhaust systems of the ventilator, whereas in non-mechanically ventilated subjects, the IDC circuit was connected to an airtight canopy that covered the subject's head and neck and delivered a measured constant flow of air (21% O 2 ).…”

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confidence: 99%

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Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

et al. 2015

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Objective: To analyze the impact of inflammation and negative nitrogen balance (NBAL) on nutritional status and outcomes after subarachnoid hemorrhage (SAH).Methods: This was a prospective observational study of SAH patients admitted between May 2008 and June 2012. Measurements of C-reactive protein (CRP), transthyretin (TTR), resting energy expenditure (REE), and NBAL (g/day) were performed over 4 preset time periods during the first 14 postbleed days (PBD) in addition to daily caloric intake. Factors associated with REE and NBAL were analyzed with multivariable linear regression. Hospital-acquired infections (HAI) were tracked daily for time-to-event analyses. Poor outcome at 3 months was defined as a modified Rankin Scale score $4 and assessed by multivariable logistic regression.Results: There were 229 patients with an average age of 55 6 15 years. Higher REE was associated with younger age (p 5 0.02), male sex (p , 0.001), higher Hunt Hess grade (p 5 0.001), and higher modified Fisher score (p 5 0.01). Negative NBAL was associated with lower caloric intake (p , 0.001), higher body mass index (p , 0.001), aneurysm clipping (p 5 0.03), and higher CRP:TTR ratio (p 5 0.03). HAIs developed in 53 (23%) patients on mean PBD 8 6 3. Older age (p 5 0.002), higher Hunt Hess (p , 0.001), lower caloric intake (p 5 0.001), and negative NBAL (p 5 0.04) predicted time to first HAI. Poor outcome at 3 months was associated with higher Hunt Hess grade (p , 0.001), older age (p , 0.001), negative NBAL (p 5 0.01), HAI (p 5 0.03), higher CRP:TTR ratio (p 5 0.04), higher body mass index (p 5 0.03), and delayed cerebral ischemia (p 5 0.04).Conclusions: Negative NBAL after SAH is influenced by inflammation and associated with an increased risk of HAI and poor outcome. Underfeeding and systemic inflammation are potential modifiable risk factors for negative NBAL and poor outcome after SAH. Neurology ® 2015;84:680-687 GLOSSARY CRP 5 C-reactive protein; DCI 5 delayed cerebral ischemia; HAI 5 hospital-acquired infection; ICU 5 intensive care unit; IDC 5 indirect calorimetry; mRS 5 modified Rankin Scale; NBAL 5 nitrogen balance; PBD 5 postbleed day; REE 5 resting energy expenditure; SAH 5 subarachnoid hemorrhage; SHOP 5 SAH outcomes project; TTR 5 transthyretin; UUN 5 urine urea nitrogen.Aneurysmal subarachnoid hemorrhage (SAH) is a significant contributor to all stroke-related potential years of life lost before age 65 years.1 Much of this is attributed to delayed cerebral ischemia (DCI).2 However, recent studies have found that both medical and infectious complications are significant independent contributors to morbidity and mortality after SAH.3-5 We previously found an association between poor nutritional status and infectious complications acutely after SAH. 6 Malnutrition has been associated with impaired immunologic function leading to increased rates of infection. 7 An assessment of nutritional profiles measured by indirect calorimetry (IDC) found SAH patients to have average resting energy expenditure (REE) rates ...

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Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

et al. 2015

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“…Food rich in flavanols, particularly cocoa, may improve endothelial function in general [299]. Food rich in omega-3 fatty acids improves vascular regulation [300]. We also recommend green tea [301].…”

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confidence: 99%

The primary vascular dysregulation syndrome: implications for eye diseases

2013

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Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.

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“…[ 32 ] Free fatty acids ( n = 6) released during lipolysis of TG induce lipid peroxidative injury. [ 2 ] Excess fat reserve or metabolic syndrome associated with elevated TG levels may also cause release of pro-inflammatory adipokines and/or endothelial dysfunction. [ 27 ] Higher skin-fold measures of adiposity have been noted to be significantly associated with vasospasm.…”

Section: Discussionmentioning

confidence: 99%

Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation?

et al. 2015

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Background:Serum lipid abnormalities are known to be important risk factors for vascular disorders. However, their role in delayed cerebral ischemia (DCI), the major cause of morbidity after subarachnoid hemorrhage (SAH) remains unclear. This study was an attempt to evaluate the spectrum of lipid profile changes in SAH compared to matched controls, and their relation with the occurrence of DCI.Methods:Admission serum lipid profile levels were measured in patients of SAH and prospectively studied in relation to various factors and clinical development of DCI.Results:Serum triglyceride (TG) levels were significantly lower among SAH patients compared to matched controls (mean [±standard deviation (SD)] mg/dL: 117.3 [±50.4] vs. 172.8 [±89.1], P = 0.002), probably because of energy consumption due to hypermetabolic response. Patients who developed DCI had significantly higher TG levels compared to those who did not develop DCI (mean [±SD] mg/dL: 142.1 [±56] vs. 111.9 [±54], P = 0.05). DCI was noted in 62% of patients with TG >150 mg/dL, compared to 22% among the rest (P = 0.01). Total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and lipoprotein (a) neither showed a significant difference between SAH and controls and nor any significant association with DCI. Multivariate analysis using binary logistic regression adjusting for the effects of age, sex, systemic disease, World Federation of Neurosurgical Societies grade, Fisher grade, and clipping/coiling, revealed higher TG levels to have significant independent association with DCI (P = 0.01).Conclusions:Higher serum TG levels appear to be significantly associated with DCI while other lipid parameters did not show any significant association. This may be due to their association with remnant cholesterol or free fatty acid-induced lipid peroxidation.

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Free Fatty Acids and Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Cited by 29 publications

References 22 publications

Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

Inflammation, negative nitrogen balance, and outcome after aneurysmal subarachnoid hemorrhage

The primary vascular dysregulation syndrome: implications for eye diseases

Serum lipid profile spectrum and delayed cerebral ischemia following subarachnoid hemorrhage: Is there a relation?

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