Plasma Glutamine Concentrations in Liver Failure

Abstract

BackgroundHigher than normal plasma glutamine concentration at admission to an intensive care unit is associated with an unfavorable outcome. Very high plasma glutamine levels are sometimes seen in both acute and chronic liver failure. We aimed to systematically explore the relation between different types of liver failure and plasma glutamine concentrations.MethodsFour different groups of patients were studies; chronic liver failure (n = 40), acute on chronic liver failure (n = 20), acute fulminant liver failure (n = 20), and post-hepatectomy liver failure (n = 20). Child-Pugh and Model for End-stage Liver Disease (MELD) scores were assessed as indices of liver function. All groups except the chronic liver failure group were followed longitudinally during hospitalisation. Outcomes were recorded up to 48 months after study inclusion.ResultsAll groups had individuals with very high plasma glutamine concentrations. In the total group of patients (n = 100), severity of liver failure correlated significantly with plasma glutamine concentration, but the correlation was not strong.ConclusionLiver failure, regardless of severity and course of illness, may be associated with a high plasma glutamine concentration. Further studies are needed to understand whether high glutamine levels should be regarded as a biomarker or as a contributor to symptomatology in liver failure.

Glutaminemia prognostic significance in critical surgical patients – An analysis of plasma aminogram profile; Significado pronóstico de la glutaminemia en pacientes quirúrgicos críticos - Análisis del perfil del aminograma plasmático

“…A SAPS II score higher than 32 revealed to be a predictive factor of severe hypoglutaminemia with high sensitivity and negative predictive values. Positive correlations between glutaminemia at admission and hepatic SOFA scores at admission and at the third and sixth days were in concordance with the association between liver dysfunction and high plasma glutamine concentrations described in the literature (31). The present findings did not corroborate the inverse correlation between admission glutaminemia and C-reactive protein levels observed by Nienaber A et al (32) in a mixed ICU patients cohort.…”

“…Severe glutamine depletion in critically ill patients, with plasma levels under 420 µmol/l, has been considered as a pejorative prognostic factor (2,3) and has demonstrated a variable prevalence, described between 25 and 67% (1,12,30,31). In addition, high baseline plasma concentrations of glutamine have been also associated with increased mortality rate.…”

“…Considering the high variability of glutaminemia at admission in ICU (1,12,30,31), the potential benefits of supplementation on glutamine-depleted patients (1,(8)(9)(10) and the risks of the glutamine administration in cases with high plasma concentration (2,11), A. Glutaminemia profile in hospital surviving (n = 21) and non-surviving (n = 7) surgical critically ill patients at the moment of admission in the intensive care unit (ICU), at the first and third days, and in historical reference healthy subjects (23) (n = 11). Comparisons were performed with the Student's-t test (with reference group) and paired Student's-t test (between the ICU moments of evaluation).…”

Plasma Glutamine Levels in Relation to Intensive Care Unit Patient Outcome

“…Oudemans-van Straaten et al [17] also reported low glutamine levels with a narrow range for the sepsis group, although the patients with sepsis in their study also had some outliers. Other groups have also reported on liver failure patients having elevated glutamine levels [16], with Helling et al [24] reporting a correlation between plasma glutamine levels and severity of liver disease. The former group proposed that liver glutamine uptake is reduced in cases of liver damage, resulting in raised plasma levels [16].…”

Is the glutamine story over?

“…Furthermore, in a study of consecutive patients admitted to the ICU, an association between hyperglutaminemia at ICU admittance and an unfavorable outcome was seen [12]. On the contrary, no general connection between hyperglutaminemia at ICU admission and an unfavorable outcome could be demonstrated in a selected population of only patients with liver failure [28]. …”