Metabolic abnormalities associated with postoperative organ failure. A redox theory.
We studied metabolic abnormalities of postoperative organ failure in 55 patients and classified them into four groups according to the postoperative changes in the arterial blood-ketone body ratio (acetoacetic acid-beta-hydroxybutyric acid) reflecting hepatic mitochondrial redox potential: patients in group A had no decrease below 0.7, patients in group B had a transient decrease to 0.4, patients in group C had a progressive decrease to below 0.4, and patients in group D (terminal stage) had a decrease to below 0.25. All group A and B patients tolerated their operations well; the group C and D patients had multiple organ failure. In groups B, C, and D, plasma concentrations of alanine, proline, phenylalanine, and tyrosine were negatively correlated with the blood--ketone body ratio and the molar ratios between the plasma concentrations of branched-chain amino acids and aromatic amino acids were positively correlated with the blood--ketone body ratio. Hepatic energy deficit associated with decreasing blood-ketone body ratio may be the metabolic basis of postoperative organ failure.
D020155:3-Hydroxybutyric Acid; D000090:Acetoacetates / Q000097:blood; D000293:Adolescent; D000328:Adult; D000368:Aged; D000596:Amino Acids / Q000378:metabolism; D002648:Child; D005260:Female; D006801:Humans; D006885:Hydroxybutyrates / Q000097:blood; D007659:Ketones / Q000097:blood; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000378:metabolism*; D010084:Oxidation-Reduction; D011183:Postoperative Complications / Q000378:metabolism; D013997:Time Factors
D000090:Acetoacetates; D000596:Amino Acids; D006885:Hydroxybutyrates; D007659:Ketones; D020155:3-Hydroxybutyric Acid