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Fluctuations of Nutrition-Associated Markers After Decompressive Hemicraniectomy in Middle Cerebral Artery Occlusion Patients

  • Nobuo Kutsuna
  • Kotaro Makita
  • Kosei Goto
  • Koki Hirayama
  • Goro Kido
  • Yukihide Kagawa
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1072)

Abstract

Cerebral infarction (CI) caused by middle cerebral artery occlusion exhibits a very high mortality rate. To reduce this rate, a decompressive hemicraniectomy (DHC) is performed clinically based on several randomized trials. In ischemic stroke, a state of malnutrition leads to poor outcomes. However, little evidence is available on nutrition state in the acute phase after DHC. This preliminary study focuses on serum markers, especially dynamic or static nutrition-associated markers including prealbumin, transferrin, retinol binding protein (RBP) and serum albumin under tube feeding with Peptamen®AF (Nestlé Health Science Japan). Blood samples were collected from four patients and analyzed at 6 time points over 14 days (preoperative day, post-operative day (POD) 1, POD 3, POD 7, POD 10, and POD 14). One-way analysis of variance (ANOVA), post hoc Least Significant Difference (LSD), was employed to analyze the blood levels at each time point. The prealbumin and RBP levels showed no significant difference between preoperation and POD 3, although they decreased gradually, while transferrin decreased significantly between the preoperative day and POD 3 (P < 0.05). The level increased significantly on POD 14 as compared to POD 3 (P < 0.05) for each dynamic marker, respectively. The albumin value decreased significantly on POD 3 to POD 7 as compared to the preoperational day (P < 0.05), while the total protein fell significantly on POD 3 (P < 0.05). The total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride, glucose, transferrin, and C-reactive protein were also investigated. Some markers fluctuated significantly, especially on POD 3. The duration may represent a hypercatabolic phase for malignant cerebral infarction with DHC. Based on these findings, further investigations among these markers, the tube fed contents, physiological changes and disability could lead to better outcomes following malignant CI.

Notes

Acknowledgments

Special thanks are due to all staff members of Sonoda Daiichi Hospital. In particular, we express our appreciation to Mrs. Noriko Oshiyama (chief nurse of neurosurgery), Mrs. Kumi Kimura (registered dietitian), Miss Ami Fujimoto (registered dietitian), and Mr. Norio Sugama (chief pharmacist) for preparing the tube feeding protocol used in the patients. We have no conflicts of interest to declare. This research has not received any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

  1. 1.
    Jüttler E et al (2007) Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery. (DESTINY): a randomized, controlled trial. Stroke 38(9):2518–2525CrossRefPubMedGoogle Scholar
  2. 2.
    Berrouschot J et al (1998) Mortality of space-occupying (‘malignant’) middle cerebral artery infarction under conservative intensive care. Intensive Care Med 24(6):620–623CrossRefPubMedGoogle Scholar
  3. 3.
    Hacke W et al (1996) Malignant middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol 53(4):309–315CrossRefPubMedGoogle Scholar
  4. 4.
    Jüttler E et al (2011) DESTINY II: DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY II. Int J Stroke 6(1):79–86CrossRefPubMedGoogle Scholar
  5. 5.
    Hofmeijer J et al (2009) Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle cerebral artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 8(4):326–333CrossRefPubMedGoogle Scholar
  6. 6.
    Vahedi K et al (2007) Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL trial). Stroke 38(9):2506–2517CrossRefPubMedGoogle Scholar
  7. 7.
    Vahedi K et al (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6(3):215–222CrossRefPubMedGoogle Scholar
  8. 8.
    Rahme R et al (2012) Decompressive hemicraniectomy for malignant middle cerebral artery territory infarction: is life worth living? J Neurosurg 117(4):749–754CrossRefPubMedGoogle Scholar
  9. 9.
    Da’valos A et al (1996) Effect of malnutrition after acute stroke on clinical outcome. Stroke 27(6):1028–1032CrossRefGoogle Scholar
  10. 10.
    FOOD Trial Collaboration (2003) Poor nutritional status on admission predicts poor outcomes after stroke: observational data from the FOOD trial. Stroke 34(6):1450–1456CrossRefGoogle Scholar
  11. 11.
    Gariballa SE et al (1998) Influence of nutritional status on clinical outcome after acute stroke. Am J Clin Nutr 68(2):275–281CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Yoo SH et al (2008) Undernutrition as a predictor of poor clinical outcomes in acute ischemic stroke patients. Arch Neurol 65(1):39–43CrossRefPubMedGoogle Scholar
  13. 13.
    Inoue Y et al (1995) Rapid turnover proteins as a prognostic indicator in cancer patients. Surg Today 25(6):498–506CrossRefPubMedGoogle Scholar
  14. 14.
    Bouharras-El Idrissi H et al (2016) Prognostic value of severity by various visceral proteins in critically ill patients with SIRS during 7 days of stay. Nutr Hosp 33(6):1276–1282CrossRefPubMedGoogle Scholar
  15. 15.
    Mól N, Kwinta P (2015) How to determine the nutritional status of preterm babies? – review of the literature. Dev Period Med 19(3 Pt 1):324–329PubMedGoogle Scholar
  16. 16.
    Jukic T et al (2015) Dynamics of inflammation biomarkers C-reactive protein, leukocytes, neutrophils, and CD64 on neutrophils before and after major surgical procedures to recognize potential postoperative infection. Scand J Clin Lab Invest 75(6):500–507CrossRefPubMedGoogle Scholar
  17. 17.
    Chung YG et al (2011) Comparison of serum CRP and procalcitonin in patients after spine surgery. J Korean Neurosurg Soc 49(1):43–48CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Takahashi J et al (2001) Early-phase enhanced inflammatory reaction after spinal instrumentation surgery. Spine (Phila Pa 1976) 26(15):1698–1704CrossRefGoogle Scholar
  19. 19.
    Tykocki T et al (2014) Analysis of the serum components in acute period after subarachnoid hemorrhage. Turk Neurosurg 24(5):672–678PubMedGoogle Scholar
  20. 20.
    Pierce BL et al (2009) Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. J Clin Oncol 27(21):3437–3444CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Kodama J et al (1999) Serum C-reactive protein as a prognostic factor in patients with epithelial ovarian cancer. Eur J Obstet Gynecol Reprod Biol 82(1):107–110CrossRefPubMedGoogle Scholar
  22. 22.
    Jüttler E et al (2014) Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med 370(12):1091–1100CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nobuo Kutsuna
    • 1
    • 2
  • Kotaro Makita
    • 1
    • 2
  • Kosei Goto
    • 1
    • 2
  • Koki Hirayama
    • 1
    • 2
  • Goro Kido
    • 1
  • Yukihide Kagawa
    • 1
  1. 1.Department of NeurosurgerySonoda Daiichi HospitalTokyoJapan
  2. 2.Division of Neurosurgery, Department of Neurological SurgeryNihon University School of MedicineTokyoJapan

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