Low plasma glutamine after multiple trauma: relationship with intracellular glutamine in polymorphonuclear neutrophils during prolonged ICU stay.
BACKGROUND
Aim of the study was to evaluate whether low plasma glutamine (GLN) is related to low intracellular GLN in stress-affected cells such as polymorphonuclear neutrophil (PMN). We hypothesized, that because low plasma GLN is assumed to have an impact on clinical outcome, stress-affected cells may also show low GLN contents.


METHODS
Thirty-nine consecutive severely injured trauma patients staying at least 10 days at a surgical intensive care unit (ICU) of a university hospital were separated into two groups: group one (n = 16) with low plasma GLN (< 420 micromol/l in average during ICU stay), and group two (n = 23) with normal plasma GLN. Initial blood samples for GLN analyses were collected within 24 h of admission at ICU. Further blood samples were taken on days 5 and 10 at 08:00 hours.


RESULTS
Patients in both groups showed no differences regarding demographic data, surgical interventions or infections. Acute physiology and chronic health evaluation (APACHE) II and the sequential organ failure assessment (SOFA) score and mortality rate were also comparable. During the study period, intracellular PMN GLN contents and concentrations did not differ between both groups. On the first day, intracellular PMN GLN content in the low plasma GLN group peaked at 5.01 +/- 3.06 x 10(-16) mol and in normal plasma GLN group at 4.73 +/- 2.57 x 10(-16) mol above the level of healthy individuals. In both groups, content decreased significantly towards the end of the observation period (group one: 2.79 +/- 1.59 x 10(-16) mol and group two: 2.63 +/- 1.71 x 10(-16) mol). A correspondent course could be observed for cell volumes. In contrast, variation of intracellular GLN concentrations remained within the reference range throughout the observation period: group one 836 +/- 510 micromol/l on day 1 and 582 +/- 331 micromol/l on day 10, and group two 788 +/- 428 micromol/l on day 1 and 548 +/- 356 micromol/l on day 10. No correlation between plasma GLN and intracellular GLN was found in either group.


CONCLUSIONS
No association between low plasma GLN and low intracellular GLN in PMN was found in a cohort of severely injured trauma patients with a minimum stay of 10 days at ICU.
Engel
J M
JM
Department of Anaesthesiology, Intensive Care Medicine, Pain Management, University Hospital, Giessen, Germany. Joerg.Engel@chiru.med.uni-giessen.de
Mühling
J
J
Weiss
S
S
Löhr
T
T
Simonis
Y
Y
Menges
T
T
Hempelmann
G
G
D000328:Adult; D002851:Chromatography, High Pressure Liquid; D004750:Enteral Nutrition; D005260:Female; D005973:Glutamine / Q000097:blood*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood*; D009504:Neutrophils / Q000378:metabolism*; D011446:Prospective Studies; D016896:Treatment Outcome
D005973:Glutamine