title: Differential effects of sepsis and trauma on urinary excretion of polyamines.
abstract: Urinary excretion of polyamines increases in patients with trauma and infection. To separate the effect of infection from the general metabolic response to sepsis, we studied 7 patients with sepsis and 13 patients with multiple trauma in the intensive-care unit. Urinary excretion of total and free polyamines, putrescine, spermidine, spermine, and their metabolites N1-acetylspermidine (N1-AcSPD) and N8-acetylspermidine (N8-AcSPD), and energy and nitrogen balance were measured. The patients were randomized to receive either hypocaloric glucose alone or with amino acids for 2 days. The excretion of individual polyamines, except spermine, significantly exceeded normal values in both patient groups; the excretion of total polyamines was 530 and 323% higher than normal in patients with sepsis and trauma, respectively. The excretion of N1-AcSPD and total spermidine was 141 and 74% higher in patients with sepsis than in patients with trauma, respectively (p < 0.05), whereas the excretion of N8-AcSPD was equal in both patient groups. This was also reflected as a significantly increased urinary ratio of N1-AcSPD to N8-AcSPD in septic patients (6.37 +/- 1.61; mean +/- SE) compared with patients after injury (2.69 +/- 0.27, p < 0.01) or a healthy population (1.08 +/- 0.04, p < 0.001). Amino acid infusion had no effect on polyamine excretion. The mean energy balance was -17.0 +/- 1.1 and -19.1 +/- 1.1 kcal.kg-1.day-1, and the mean nitrogen balance was -0.17 +/- 0.03 and -0.15 +/- 0.02 g.kg-1.day-1 in patients with sepsis and trauma, respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Critical Care Research Program, Kuopio University Central Hospital, Finland.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pöyhönen
authors.forename: J A
authors.initials: JA
authors.lastname: Takala
authors.forename: O
authors.initials: O
authors.lastname: Pitkänen
authors.forename: A
authors.initials: A
authors.lastname: Kari
authors.forename: L A
authors.initials: LA
authors.lastname: Alakuijala
authors.forename: T O
authors.initials: TO
authors.lastname: Eloranta
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016470:Bacteremia / Q000378:metabolism / Q000628:therapy; D001424:Bacterial Infections / Q000378:metabolism* / Q000628:therapy; D002177:Candidiasis / Q000378:metabolism / Q000628:therapy; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D016469:Fungemia / Q000378:metabolism / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000378:metabolism* / Q000628:therapy; D009584:Nitrogen / Q000378:metabolism; D010288:Parenteral Nutrition; D011073:Polyamines / Q000652:urine*; D011700:Putrescine / Q000652:urine; D013095:Spermidine / Q000652:urine; D013096:Spermine / Q000652:urine
chemical_list: D011073:Polyamines; D013096:Spermine; D009584:Nitrogen; D013095:Spermidine; D011700:Putrescine