Citrulline: just a biomarker or a conditionally essential amino acid and a pharmaconutrient in critically ill patients?

Cynober, Luc

doi:10.1186/cc12534

Cited by 23 publications

(18 citation statements)

References 15 publications

(18 reference statements)

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“…There are three main hypotheses for explaining the link observed between small bowel mucosal damage and poor prognosis. First, gut damage by itself might explain the poor prognosis, small bowel ischemia associated with no-flow and low-flow periods inducing bacterial translocation (16), high level of systemic inflammation, and a possible decrease in arginine bioavailability (32). All in all, small bowel ischemia seems to be closely linked to the development of post-cardiac arrest syndrome (33,34).…”

Section: Discussionmentioning

confidence: 99%

Enterocyte Damage

Piton

Belin

Barrot

et al. 2015

Shock

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Cardiac arrest is considered to be a cause of small bowel ischemia, but the consequences of cardiac arrest on the human small bowel have been rarely studied. Plasma citrulline concentration is a marker of functional enterocyte mass, and plasma intestinal fatty acid-binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to measure enterocyte biomarkers after cardiac arrest and to study the prognostic value of biomarker abnormalities. This is a prospective, observational, single-center study of patients admitted to the intensive care unit (ICU) for cardiac arrest, evaluating plasma citrulline and I-FABP concentrations at admission and after 24 h and variables according to the Utstein criteria. Variables according to 28-day Cerebral Performance Category score of 1 to 2 (good neurological outcome) versus 3 to 5 (poor neurological outcome) were compared. Sixty-nine patients with cardiac arrest of both cardiac and hypoxic origin were included. At ICU admission, plasma citrulline concentration was low in 65% and plasma I-FABP was elevated in 82% of the patients. After 24 h, plasma citrulline was low in 82% and I-FABP was normal in 60% of the patients. Patients with a poor neurological outcome had a lower plasma citrulline concentration and a higher I-FABP concentration at ICU admission. By multivariate analysis, plasma citrulline levels of 13.1 μmol L or less and I-FABP more than 260 pg mL were independently associated with a poor neurological outcome (odds ratio, 21.9 [2.2-215], and odds ratio, 13.6 [1.4-129], respectively). Cardiac arrest resuscitation is associated with evidence of small bowel mucosal damage in most patients, with a short and intense I-FABP elevation at admission and a decrease in citrulline concentration during the first day. In this study, low plasma citrulline and high I-FABP concentrations at ICU admission were predictive of a poor neurological outcome. This study confirms that cardiac arrest is a model of small bowel mucosal ischemia and suggests that enterocyte damage is a piece in the puzzle of post-cardiac arrest syndrome.

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Section: Discussionmentioning

confidence: 99%

Enterocyte Damage

Piton

Belin

Barrot

et al. 2015

Shock

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“…Few studies have focused specifically on obese septic patients, with most evidence indicating that obesity is protective in the context of sepsis. Studies in hospitalized septic patients show that obese patients have lower in-hospital (40), 28-day (87), and 1-year (65) mortality rates, respectively, as compared to nonobese patients. One of these studies also examined plasma pro-inflammatory cytokine levels, with decreased interleukin-6 levels being found in obese patients (87).…”

Section: Obesity and Animal Models Of Critical Illnessmentioning

confidence: 99%

“…Studies in hospitalized septic patients show that obese patients have lower in-hospital (40), 28-day (87), and 1-year (65) mortality rates, respectively, as compared to nonobese patients. One of these studies also examined plasma pro-inflammatory cytokine levels, with decreased interleukin-6 levels being found in obese patients (87). Conversely, one small study (149 patients) did identify obesity as a strong risk factor for 30-day mortality in patients with bacteremia (28).…”

Section: Obesity and Animal Models Of Critical Illnessmentioning

confidence: 99%

Obesity and Critical Illness

Mittwede

Clemmer

Bergin

et al. 2016

Shock

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Critical illness is a major cause of morbidity and mortality around the world. While obesity is often detrimental in the context of trauma, it is paradoxically associated with improved outcomes in some septic patients. The reasons for these disparate outcomes are not well understood. A number of animal models have been used to study the obese response to various forms of critical illness. Just as there have been many animal models that have attempted to mimic clinical conditions, there are many clinical scenarios that can occur in the highly heterogeneous critically ill patient population that occupies hospitals and intensive care units. This poses a formidable challenge for clinicians and researchers attempting to understand the mechanisms of disease and develop appropriate therapies and treatment algorithms for specific subsets of patients, including the obese. The development of new, and the modification of existing animal models is important in order to bring effective treatments to a wide range of patients. Not only do experimental variables need to be matched as closely as possible to clinical scenarios, but animal models with pre-existing comorbid conditions need to be studied. This review briefly summarizes animal models of hemorrhage, blunt trauma, traumatic brain injury, and sepsis. It also discusses what has been learned through the use of obese models to study the pathophysiology of critical illness in light of what has been demonstrated in the clinical literature.

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“…Arg availability is increased in sepsis mainly by protein breakdown, but Arg catabolism is also increased due to its enhanced utilization for NO synthesis and higher arginase activity. Its utility as a marker in sepsis or critically ill patients is doubtful because of associated vascular abnormalities, acute renal failure and/or multiple organ failure, or comorbid conditions (Cynober, 2013). Because data for Cit in intensive care units are not available, large clinical trials are warranted before any reliable recommendations can be made for Cit-enriched diets.…”

Section: Citrulline In Sepsismentioning

confidence: 99%