Effects of glucocorticoids on serum amino acid levels during cardiac surgery in children

Zwol, Annelies van; Oosterloo, Neelke B.C.; Betue, C.T. de; Bogers, Ad J.J.C.; Liefde, Inge I. de; Deutz, N.E.P.; Joosten, Koen

doi:10.1016/j.clnesp.2017.09.012

Cited by 4 publications

(7 citation statements)

References 29 publications

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“…In the present study, preoperative supplementation of Gln/Arg/HMB (14/14/3 g/day, respectively) for 1 month Table 3 Comparison of the hepatic biomarkers between groups at the baseline and end of the study 1 1 CPK creatine phosphokinase, CPK-MB creatine phosphokinase myocardial band, AST aspartate aminotransferase, ALT alanine aminotransferase 2 Data are presented as mean ± SD for normally distributed continuous variables or as median (IQR) for non-normally distributed continuous variables 3 Calculated using the independent sample t-test (variables that entered as logarithm form are indicated by "**") or Mann-Whitney U-test (indicated by "*") 4 Calculated using ANCOVA (variables that entered as logarithm form are indicated by "**") or non-parametric ranked ANCOVA using generalized estimation equation (indicated by " ¥" ), adjusted for the effect of BMI, age, gender, and history of HTN 5 Calculated using the paired t-test or Wilcoxon rank test (indicated by "*") improved recovery and reduced the duration of stay in hospital and ICU, the time to start food intake, and markers of myocardial injury (troponin and CPK-MB) after cardiac surgery. The nutritional risk and LVEF were not different after supplementation between the two groups.…”

Section: Discussionmentioning

confidence: 99%

“…1 NPO nothing per oral, ICU intensive care unit 2 Data are presented as median (IQR) 3 Calculated using the Mann-Whitney U-test 4 Calculated using generalized estimation equation (indicated by " ¥ "), adjusted for the effect of BMI, age, gender, and history of HTN of conflicting findings may be due to the short duration of the intervention, the time of onset of the intervention, the small sample size, and the different physiological conditions between the diseases.…”

Section: Discussionmentioning

confidence: 99%

“…1 CPK creatine phosphokinase, CPK-MB creatine phosphokinase myocardial band, LVEF left ventricular ejection fraction, SOFA Sequential Organ Failure Assessment 2 Data are presented as mean ± SD for normally distributed continuous variables or as median (IQR) for non-normally distributed continuous variables 3 Calculated using the independent sample t-test (variables that entered as logarithm form are indicated by "**") or Mann-Whitney U-test (indicated by "*") 4 Calculated using ANCOVA (variables that entered as logarithm form are indicated by "**") or non-parametric ranked ANCOVA using generalized estimation equation (indicated by " ¥" ), adjusted for the effect of BMI, age, gender, and history of HTN 5…”

Section: Table 2 Comparison Of the Myocardial Biomarkers And Postoper...mentioning

confidence: 99%

“…Moreover, there was no difference between the groups in the time of NPO. It was found that individuals in the intervention group started receiving food, either fluid (median [IQR] = 6 [0] vs. 9 [4]) or solid (median [IQR] = 8 [0] vs. 11 [2]), earlier than the placebo group (P < 0.001). No significant difference was observed in the frequency of nausea (P = 0.212), vomiting (P = 0.127), and complications after surgery (P = 0.236) between the two groups.…”

Section: Start Of Food Intake Postoperative Complications and Nutriti...mentioning

confidence: 99%

“…Nutritional deficiencies may induce inflammation by reducing the defense system function and depleting antioxidant nutrient reserves [ 3 ]. At the other hand, some studies reported a drop in serum amino acid levels such as citrulline, arginine (Arg), and glutamine (Gln) after cardiac surgery [ 4 ]. It has been reported that the depletion of micronutrients and macronutrients in people undergoing heart surgery makes them more susceptible to sarcopenia, cachexia, surgical trauma, hemodilution, pneumonia, and infection.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, l-arginine, and l-glutamine: a double-blind randomized placebo-controlled clinical trial

Norouzi

Nadjarzadeh

Maleki

et al. 2022

Trials

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Background The preoperative period is a good time to improve nutrition status, compensate for nutrient deficiencies, and optimize immune function in patients’ underlying surgery. In some medical conditions, supplementation with a combination of l-glutamine (Gln), β-hydroxy-β-methylbutyrate (HMB), and l-arginine (Arg) had promising effects on improving recovery. The present study aimed to evaluate the effect of supplementation with Gln/Arg/HMB in patients undergoing heart surgery. Methods This randomized clinical trial was conducted on 70 patients undergoing cardiac surgery. Participants were requested to consume 2 sachets of a combination of 7 g l-arginine, 7 g l-glutamine, and 1.5 g daily HMB or placebo 30 days before operation. At the baseline and end of the study, left ventricular ejection fraction and the serum levels of troponin, creatine phosphokinase (CPK), CPK-MB, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin were measured. Also, the Sequential Organ Failure Assessment (SOFA) score, time of stay in hospital and intensive care unit (ICU), and postoperative complications were recorded after surgery. Results In total, 60 preoperative patients (30 in each group) with a mean age of 53.13 ± 14.35 years completed the study (attrition rate = 85.7%). Subjects in the Gln/Arg/HMB group had lower serum levels of CPK-MB (median [IQR] = 49 [39.75] vs. 83 [64.55]; P = 0.011), troponin (median [IQR] = 2.13 [1.89] vs. 4.34 [1.99]; P < 0.001), bilirubin (median [IQR] = 0.50 [0.20] vs. 0.40 [0.22]; P < 0.001), and SOFA score (median [IQR] = 2 [2] vs. 5 [2]; P < 0.001) at end of the study compared to the placebo. Also, the time of stay in the hospital (median [IQR] = 5 [1] vs. 6 [3]; P < 0.001) and ICU (median [IQR] = 2.50 [1.00] vs. 3.50 [1.50]; P = 0.002) was lower in the Gln/Arg/HMB group. Conclusion The present study showed that perioperative supplementation with a combination of Gln, Arg, and HMB enhances the recovery, reduces myocardial injury, and decreases the time of hospital and ICU stay in cardiac surgery patients. These results need to be confirmed in a larger trial. Trial registration IRCT.ir IRCT20120913010826N31. Registered on 13 October 2020.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Table 2 Comparison Of the Myocardial Biomarkers And Postoper...mentioning

confidence: 99%

Section: Start Of Food Intake Postoperative Complications and Nutriti...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, l-arginine, and l-glutamine: a double-blind randomized placebo-controlled clinical trial

Norouzi

Nadjarzadeh

Maleki

et al. 2022

Trials

View full text Add to dashboard Cite

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Nutrition for critically ill children with congenital heart disease

Kerstein,

Klepper,

Finnan

et al. 2023

Nut in Clin Prac

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Children with congenital heart disease often require admission to the cardiac intensive care unit at some point in their lives, either after elective surgical or catheter‐based procedures or during times of acute critical illness. Meeting both the macronutrient and micronutrient needs of children in the cardiac intensive care unit requires complex decision‐making when considering gastrointestinal perfusion, vasoactive support, and fluid balance goals. Although nutrition guidelines exist for critically ill children, these cannot always be extrapolated to children with congenital heart disease. Children with congenital heart disease may also suffer unique circumstances, such as chylothoraces, heart failure, and the need for mechanical circulatory support, which greatly impact nutrition delivery. Guidelines for neonates and children with heart disease continue to be developed. We provide a synthesized narrative review of current literature and considerations for nutrition evaluation and management of critically ill children with congenital heart disease.

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Metabolomic Fingerprinting of Infants Undergoing Cardiopulmonary Bypass: Changes in Metabolic Pathways and Association With Mortality and Cardiac Intensive Care Unit Length of Stay

Davidson

Pfeifer

Frank

et al. 2018

JAHA

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Background Mortality for infants undergoing complex cardiac surgery is >10% with a 30% to 40% risk of complications. Early identification and treatment of high‐risk infants remains challenging. Metabolites are small molecules that determine the minute‐to‐minute cellular phenotype, making them ideal biomarkers for postsurgical monitoring and potential targets for intervention. Methods and Results We measured 165 serum metabolites by tandem mass spectroscopy in infants ≤120 days old undergoing cardiopulmonary bypass. Samples were collected prebypass, during rewarming, and 24 hours after surgery. Partial least squares–discriminant analysis, pathway analysis, and receiver operator characteristic curve analysis were used to evaluate changes in the metabolome, assess altered metabolic pathways, and discriminate between survivors/nonsurvivors as well as upper/lower 50% intensive care unit length of stay. Eighty‐two infants had preoperative samples for analysis; 57 also had rewarming and 24‐hour samples. Preoperation, the metabolic fingerprint of neonates differed from older infants ( R 2 =0.89, Q 2 =0.77; P <0.001). Cardiopulmonary bypass resulted in progressive, age‐independent metabolic disturbance ( R 2 =0.92, Q 2 =0.83; P <0.001). Multiple pathways demonstrated changes, with arginine/proline ( P =1.2×10 −35 ), glutathione ( P =3.3×10 −39 ), and alanine/aspartate/glutamate ( P =1.4×10 −26 ) metabolism most affected. Six subjects died. Nonsurvivors demonstrated altered aspartate ( P =0.007) and nicotinate/nicotinamide metabolism ( P =0.005). The combination of 24‐hour aspartate and methylnicotinamide identified nonsurvivors versus survivors (area under the curve, 0.86; P <0.01), as well as upper/lower 50% intensive care unit length of stay (area under the curve, 0.89; P <0.01). Conclusions The preoperative metabolic fingerprint of neonates differed from older infants. Large metabolic shifts occurred after cardiopulmonary bypass, independent of age. Nonsurvivors and subjects requiring longer intensive care unit length of stay showed distinct changes in metabolism. Specific metabolites, including aspartate and methylnicotinamide, may differentiate sicker patients from those experiencing a more benign course.

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Effects of glucocorticoids on serum amino acid levels during cardiac surgery in children

Cited by 4 publications

References 29 publications

Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, l-arginine, and l-glutamine: a double-blind randomized placebo-controlled clinical trial

Evaluation of the recovery after heart surgery following preoperative supplementation with a combination of beta-hydroxy-beta-methylbutyrate, l-arginine, and l-glutamine: a double-blind randomized placebo-controlled clinical trial

Nutrition for critically ill children with congenital heart disease

Metabolomic Fingerprinting of Infants Undergoing Cardiopulmonary Bypass: Changes in Metabolic Pathways and Association With Mortality and Cardiac Intensive Care Unit Length of Stay

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