Altered balance of the aminogram in patients with sepsis – The relation to mortality

Hirose, Tomoya; Shimizu, Kentaro; Ogura, Hiroshi; Tasaki, Osamu; Hamasaki, Toshimitsu; Yamano, Shuhei; Ohnishi, Mitsuo; Kuwagata, Yasuyuki; Shimazu, Takeshi

doi:10.1016/j.clnu.2013.11.017

Cited by 43 publications

(28 citation statements)

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“…The frequency of patients with low baseline plasma GLN levels is extremely variable and is not consistent [31, 73, 74]. There is no association of baseline plasma GLN and Acute Physiology and Chronic Health Evaluation II score, as could be expected when the severity of illness plays a role in conditional deficiency [74].…”

Section: Discussionmentioning

confidence: 99%

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Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis

et al. 2015

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IntroductionGlutamine (GLN) has been suggested to have a beneficial influence on outcomes of critically ill patients. However, recent large-scale trials have suggested harm associated with GLN supplementation. Recently, systematic reviews on the use of parenteral GLN have been published; however, less information is available on the role of enteral GLN. Therefore, the aim of this systematic review was to study the effects of enteral GLN supplementation in patients with critical illness.MethodsWe identified randomized controlled trials conducted from 1980 to 2014 with enterally administered GLN in adult critically ill patients. Studies of parenteral GLN only or combined enteral-parenteral GLN were excluded. The methodological quality of studies was scored, and trial data were statistically combined. We examined a priori the treatment effects in subgroups of trials of burn and trauma patients.ResultsA total of 11 studies involving 1079 adult critically ill patients and enteral GLN supplementation were identified. Enteral GLN supplementation was not associated with a reduction of hospital mortality (risk ratio [RR] 0.94, 95 % confidence interval [CI] 0.65–1.36; p =0.74), infectious complications (RR 0.93, 95 % CI 0.79–1.10; p =0.39) or stay in the intensive care unit (weighted mean difference [WMD] −1.36 days, 95 % CI −5.51 to 2.78; p =0.52). However, there was a significant reduction in hospital stay (WMD 4.73 days, 95 % CI −8.53 to −0.90; p =0.02). In the subset of studies of patients with burns, enteral GLN supplementation was associated with significant reductions in hospital mortality (RR 0.19, 95 % 0.06–0.67; p =0.010) and hospital stay (WMD −9.16, 95 % CI −15.06 to −3.26; p =0.002). There was no effect in trauma patients.ConclusionsEnteral GLN supplementation does not confer significant clinical benefit in critically ill patients, with the exception of reduced hospital stay. There may be a significant benefit in patients with burns, but data are sparse and larger randomized trials are warranted to confirm this effect.

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Section: Discussionmentioning

confidence: 99%

“…Moreover, in general and septic ICU patients, high baseline plasma GLN (>930 μmol/L) was associated with increased mortality suggesting a U-shaped association [74]. In addition, low baseline GLN levels were not always associated with increased mortality [73]. …”

Section: Discussionmentioning

confidence: 99%

Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis

et al. 2015

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“…According Gough MS et al [8], in patients with severe sepsis, the ratio of arginine-to-dimethylarginine is reduced, proportionally to the severity of the illness, and predicts the outcome. Hirose T et al [44] demonstrated that minimum values of argininemia were significantly lower in non-surviving than in surviving septic ICU patients. Recently, potential benefits of arginine monosupplementation during sepsis have been reanalyzed in experimental and clinical studies [24, 42].…”

Section: Discussionmentioning

confidence: 99%

Argininemia and plasma arginine bioavailability – predictive factors of mortality in the severe trauma patients?

et al. 2016

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BackgroundArginine is an amino acid determinant in the metabolic, immune and reparative responses to severe trauma. The present study aims to determine argininemia and plasma arginine bioavailability (PAB) in critical trauma patients and to analyze its correlation with prognosis.MethodsA prospective study of 23 critical trauma patients was undertaken. Aminoacidemias were determined, by ion exchange chromatography, at admission and in the first and third days and compared with those of 11 healthy individuals. PAB was calculated. Severity indexes and outcome parameters were recorded.ResultsValues of argininemia, citrullinemia and ornithinemia at the admission were significantly lower than those of the controls (arginine: 41.2 ± 20.6 versus 56.1 ± 11.9 μmol/L, P = 0.034). Hipoargininemia (<60 μmol/L) prevalence was 82.6 %. Mean PAB was 62.4 ± 25.6 %. Argininemia < 26 μmol/L constituted a significant predictive factor of in-hospital mortality [n = 4 (17.4 %); 75 versus 15.8 %, P = 0.04; odds ratio = 4.7; accuracy = 87 %] and lower actuarial survival (63.5 ± 43.9 versus 256.1 ± 33.3 days, P = 0.031). PAB <42 % [n = 6 (26.1 %)] was associated with higher lactacidemia levels (P = 0.033), higher in-hospital mortality (66.7 versus 11.8 %, P = 0.021; odds ratio = 5.7, accuracy = 82.6 %) and lower actuarial survival (87.2 ± 37.5 versus 261.4 ± 34.7 days, n.s.). Probability of in-hospital mortality was inversely and significantly related with PAB [61.8 ± 8.8 % (95 % CI 50.8–72.7) when PAB <41 % and 2.8 ± 1.9 % (95 % CI 1.9–8.3) when PAB > 81 %, P = 0.0001]. Charlson’s index ≥1, APACHE II ≥19.5, SOFA ≥7.5, and glutaminemia < 320 μmol/L were also predictive factors of actuarial survival.ConclusionsThose results confirm the high prevalence of arginine depletion in severe trauma patients and the relevance of argininemia and PAB as predictive factors of mortality in this context.

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“…The glutamine concentration at admission to the ward after an ICU stay > 96 hours does not predict outcome [24]. Among extreme ICU longstayers, a high plasma glutamine concentration is associated with poor outcome [25], but general hyperaminoaciemia and high concentrations of other amino acids were even stronger indicators of a poor outcome, so this particular observation was not specific for glutamine. In the study cited, the plasma concentration during ongoing IV glutamine supplementation was in the reference range, but values in the higher part of normal glutamine concentration interval added mortality prediction to the admission SAPS III [24].…”

Section: Plasma Glutamine As Proxymentioning

confidence: 99%

Is the glutamine story over?

Smedberg

Wernerman

2016

Crit Care

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Glutamine has been launched as a conditionally indispensible amino acid for the critically ill. Supplementation has been recommended in guidelines from international societies. Although data have been presented pointing out that glutamine supplementation may not be for everybody, recommendations for treatments and design of study protocols have included all critically ill patients. Results from more recent studies and meta-analyses indicate that indiscriminate use of glutamine supplementation in critically ill patients may actually cause harm rather than beneficial effects. This viewpoint sorts out arguments of controversy in the glutamine story.

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Altered balance of the aminogram in patients with sepsis – The relation to mortality

Cited by 43 publications

References 9 publications

Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis

Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis

Argininemia and plasma arginine bioavailability – predictive factors of mortality in the severe trauma patients?

Is the glutamine story over?

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