[Glutamine use for parenteral nutrition in the critically ill patient: effects on morbimortality].
OBJECTIVE
To determine the relationship between adding glutamine dipeptides to parenteral nutrition (PN) and morbimortality in the critically ill patient.


METHODS
Case-control retrospective study. The cases were patients to whom PN supplemented with 2 g of nitrogen (glutamine) was administered during the period 2001-2004. Controls were patients with PN without glutamine, collected during the year 2000. All included patients had infection defined as the presence of an infectious site plus more than two of the following criteria: leucocytes > 12.000 x 10(6)/L, fever > 38 degrees C, heart rate > 90 bmp, or PCO2 < 31 mmHg. Besides, they had to have prealbumin plasma levels < 15 g/L or albumin levels < 25 g/L, and CRP > 100 mg/L or a fistula. Patients with renal failure, previous dialysis, hepatic encephalopathy, or mixed diet were excluded from the study. Morbimortality variables collected were: hyperglycemia, renal failure, days on PN, days in the ICU, hospitalization days, and mortality.


RESULTS
Two hundred and two patients (75 cases and 127 controls) were included. In the previous univariate analysis no significant differences appeared for independent variables between both groups. In the multivariate analysis, glutamine addition was significantly associated to lower renal failure incidence (OR: 0.28; CI: 0.081.00), lower hyperglycemia (OR: 0.38; CI: 0.19-0.75), less hospitalization days (OR: 0.64; CI: 0.44-0.92), and fewer days in the ICU (OR: 0.64; CI: 0.45-0.93). For the variable "exitus", glutamine addition showed a trend towards inclusion into the model (p = 0.097). About the days on PN, the variable glutamine was not included into the model.


CONCLUSIONS
In critically ill patients, adding glutamine to PN leads to quicker recovery and lower incidence of hyperglycemia and renal failure. In view of these results, adding glutamine to PN of particular patients is an effective measure to speed up their recovery and avoid certain complications.
Mercadal Orfila
G
G
Servicio de Farmacia, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona. gmercadal@smen.es
Llop Talaverón
J M
JM
Gracia García
B
B
Martorell Puigserver
C
C
Badía Tahull
Ma B
MB
Tubau Molas
Ma
M
Jodar Masanes
R
R
D016022:Case-Control Studies; D016638:Critical Illness / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D005260:Female; D005973:Glutamine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010288:Parenteral Nutrition / Q000379:methods; D012189:Retrospective Studies
D005973:Glutamine