gms | German Medical Science

Objective: Nowadays management of malnutrition in the ICU has reached its successful peak. In addition to kidney diseases, changes in the serum Urea-Creatinine-Ratio (UCR) are used as biomarkers in disease entities such as pancreatitis and heart failure. Nevertheless, its role in the context of cerebral pathologies is unknown. We prospectively screened patients with aneurysmal subarachnoid hemorrhage for UCR to define its status as a marker for protein-metabolism or -catabolism.

Methods: We prospectively enrolled 66 adult patients (54±12.4) treated for aneurysmal SAH from 5/2014-05/2017. Twenty-three adult patients undergoing elective cardiac surgery (age 56±6.5) were recruited as a control group to account for influences by surgery/treatment alone. Measurements of UCR were collected once a day for 21 days. The treatment group was stratified into the occurrence of delayed cerebral ischemia (DCI: clinical and/or functional deterioration) or uncomplicated clinical course (noDCI), respectively. Clinical outcome was assessed using the modified Rankin Scale (mRS) at six months after SAH. MRS 4-5 was defined as an unfavorable outcome.

Results: A total of 1203 serum samples were analyzed. UCR was significantly elevated in the SAH group compared with the cardiac control group (65.7±18.2 vs. 41.8±9.0, p<0.0001). Subgroup analyses of SAH showed significant differences regarding disease severity (HH1-3 vs HH4-5: 59.8±78.8 vs. 78± 20.86, p<0.001), clinical complications (noDCI vs DCI: 55.0±13.9 vs. 72.0±19.5, p<0.001), as well as outcome (mRS 1-3 vs mRS 4-5: 58±19.2 vs. 76.5±20.7, p<0.01).

Conclusion: In this first exploratory study of UCR in the context of SAH, an increase in protein catabolism was associated with disease severity, increased complication rate and poor outcome. Prognostic or therapeutic relevance of protein catabolism should be explored further to determine optimal management of UCR in the context of SAH.