L-alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study.
OBJECTIVE
Glutamine (Gln)-supplemented total parenteral nutrition (TPN) improves clinical outcome after planned surgery, but the benefits of Gln-TPN for critically ill (intensive care unit; ICU) patients are still debated.


METHODS
Prospective, double-blind, controlled, randomized trial.


METHODS
ICUs in 16 hospitals in France.


METHODS
One-hundred fourteen ICU patients admitted for multiple trauma (38), complicated surgery (65), or pancreatitis (11).


METHODS
Patients were randomized to receive isocaloric isonitrogenous TPN via a central venous catheter providing 37.5 kcal and 1.5 g amino acids.kg-1.day-1 supplemented with either L-alanyl-L-glutamine dipeptide (0.5 g.kg-1.day-1; Ala-Gln group, n=58) or L-alanine+L-proline (control group, n=56) over at least 5 days.


RESULTS
Complicated clinical outcome was defined a priori by the occurrence of infectious complications (according to the criteria of the Centers for Disease Control and Prevention), wound complication, or death. The two groups were compared by chi-square test on an intention-to-treat basis. The two groups did not differ at inclusion for type and severity of injury (mean simplified acute physiology score II, 30 vs. 30.5; mean injury severity score, 44.9 vs. 42.3). Similar volumes of TPN were administered in both groups. Ala-Gln-supplemented TPN was associated with a lower incidence of complicated outcome (41% vs. 61%; p<.05), which was mainly due to a reduced infection rate per patient (mean, 0.45 vs. 0.71; p<.05) and incidence of pneumonia (10 vs. 19; p<.05). Early death rate during treatment and 6-month survival were not different. Hyperglycemia was less frequent (20 vs. 30 patients; p<.05) and there were fewer insulin-requiring patients (14 vs. 22; p<.05) in the Ala-Gln group.


CONCLUSIONS
TPN supplemented with Ala-Gln dipeptide in ICU patients is associated with a reduced rate of infectious complications and better metabolic tolerance.
Déchelotte
Pierre
P
Nutrition Unit, Rouen University Hospital (PD), Rouen, France.
Hasselmann
Michel
M
Cynober
Luc
L
Allaouchiche
Bernard
B
Coëffier
Moïse
M
Hecketsweiler
Bernadette
B
Merle
Véronique
V
Mazerolles
Michel
M
Samba
Désiré
D
Guillou
Yves Marie
YM
Petit
Jean
J
Mansoor
Odile
O
Colas
Gabriel
G
Cohendy
Robert
R
Barnoud
Didier
D
Czernichow
Pierre
P
Bleichner
Gérard
G
D000704:Analysis of Variance; D003422:Critical Care; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D004151:Dipeptides / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005602:France / Q000453:epidemiology; D018149:Glucose Intolerance / Q000209:etiology / Q000517:prevention & control*; D005973:Glutamine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate
D004151:Dipeptides; D005973:Glutamine; C054122:alanylglutamine