Is There a Correlation Between Circulating Levels of Citrulline and Intestinal Dysfunction in the Critically Ill?

Noordally, S. Oaleed; Sohawon, Schoeb; Semlali, Hamza; Michely, David; Devriendt, Jacques; Gottignies, Philippe

doi:10.1177/0884533612449360

Cited by 28 publications

(25 citation statements)

References 28 publications

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“…Surprisingly, the results show no difference between patients with renal failure and those without it. The same was observed in another study [7]. In the case of renal failure, CIT levels should be increased [8].…”

supporting

confidence: 75%

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

Cynober

2013

Crit Care

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Low plasma citrulline levels have been associated with a reduction of functional gut mass in various clinical situations. In critically ill patients, citrulline variations are tricky to interpret because of sepsis, vascular abnormalities, and multiple organ failure. In the previous issue of Critical Care, Ware and colleagues made an important contribution by demonstrating that very low citrulline levels are associated with acute respiratory distress syndrome. This association may be due to a decrease in citrulline availability or citrulline overconsumption for nitric oxide synthesis but also may result from an arginine deficiency syndrome. In any case, the results of this study reinforce the rationale for a study of citrulline supplementation in critically ill patients.

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supporting

confidence: 75%

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

Cynober

2013

Crit Care

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“…Several biomarkers reflecting intestinal function have been suggested recently (I-FABP, citrulline, d -lactate) [25, 26]. Future studies should establish their place in clinical practice and establish their correlations with clinical GI signs and symptoms, as well as with prognosis [27].…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study

et al. 2013

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PurposeThe study aimed to develop a gastrointestinal (GI) dysfunction score predicting 28-day mortality for adult patients needing mechanical ventilation (MV).Methods377 adult patients from 40 ICUs with expected duration of MV for at least 6 h were prospectively studied. Predefined GI symptoms, intra-abdominal pressures (IAP), feeding details, organ dysfunction and treatment were documented on days 1, 2, 4 and 7.ResultsThe number of simultaneous GI symptoms was higher in nonsurvivors on each day. Absent bowel sounds and GI bleeding were the symptoms most significantly associated with mortality. None of the GI symptoms alone was an independent predictor of mortality, but gastrointestinal failure (GIF)—defined as three or more GI symptoms—on day 1 in ICU was independently associated with a threefold increased risk of mortality. During the first week in ICU, GIF occurred in 24 patients (6.4 %) and was associated with higher 28-day mortality (62.5 vs. 28.9 %, P = 0.001). Adding the created subscore for GI dysfunction (based on the number of GI symptoms) to SOFA score did not improve mortality prediction (day 1 AUROC 0.706 [95 % CI 0.647–0.766] versus 0.703 [95 % CI 0.643–0.762] in SOFA score alone).ConclusionsAn increasing number of GI symptoms independently predicts 28 day mortality with moderate accuracy. However, it was not possible to develop a GI dysfunction score, improving the performance of the SOFA score either due to data set limitations, definition problems, or possibly indicating that GI dysfunction is often secondary and not the primary cause of other organ failure.

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“…Piton et al detected low plasma citrulline levels in 44% of ICU patients and stated that the plasma citrulline measurement could be a sensitive marker for the functional enterocyte mass (42). Noordally et al also studied intestinal dysfunction in ICU patients and found that among several parameters (SOFA-APACHE scores, CRP, pre-albumin, albumin, citrulline, inotrophic agents, and renal dysfunction) only low plasma citrulline level correlated well with intestinal dysfunction (43). As a different perspective, Yi et al reported that exogenously administered L-citrulline exhibits gastric protection by the inhibition of neutrophil infiltration, which might be related in prevention of the increase in iNOS activity in an experimental gastric ischemia reperfusion study (44).…”

Section: Discussionmentioning

confidence: 99%

“…A plasma citrulline level below 27 µmol/L is thought to suggest intestinal pathology, and a level below 15 µmol/L is accepted as a marker of severe intestinal damage (18, 36, 39, 43). These reports suggest that the plasma citrulline level may be useful in the early detection of intestinal damage.…”

Section: Discussionmentioning

confidence: 99%

A combination of plasma DAO and citrulline levels as a potential marker for acute mesenteric ischemia

Çakmaz¹,

Büyükaşık

Kahramansoy

et al. 2013

Libyan Journal of Medicine

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IntroductionThere is no valid and reliable diagnostic test for early diagnosis of acute mesenteric ischemia (AMI). The aim of this study was to measure the plasma levels of diamine oxidase (DAO) and citrulline in AMI to gain insight into its early diagnosis.Material and methodsA total of 21 Wistar albino rats were divided into three groups, that is, control group, short-term ischemia group, and prolonged ischemia group. The superior mesenteric artery was occluded for 15 min in the short-term ischemia group and for 12 h in the prolonged ischemia group. Twelve hours later, the experiment was terminated and plasma DAO and citrulline levels were measured. Intestinal tissue was evaluated for the histopathological changes.ResultsCompared to the control group, the short-term and prolonged ischemia groups showed significant increases in the plasma levels of DAO, whereas the plasma citrulline levels decreased significantly. Prolonged ischemia caused a larger increase in the plasma DAO levels and a larger decrease in the plasma citrulline levels compared to the short-term ischemia (p=0.011 and p=0.021, respectively). Intestinal damage was shown to develop more in the prolonged ischemia group (p=0.001).ConclusionIn the early period of AMI, the plasma DAO levels increase while citrulline levels decrease, and the extent of these changes depends on the duration of ischemia.

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Is There a Correlation Between Circulating Levels of Citrulline and Intestinal Dysfunction in the Critically Ill?

Abstract: Low plasma citrulline levels in patients correlate well with intestinal dysfunction.

Cited by 28 publications

References 28 publications

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

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

Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study

A combination of plasma DAO and citrulline levels as a potential marker for acute mesenteric ischemia

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